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BOOKS BY 

CHARLOTTE A. AIKENS 


Primary Studies for Nurses— i2mo of 545 pages, illus¬ 
trated. Fifth Edition. 

Clinical Studies for Nurses— i2mo of 577 pages, 
illustrated. Cloth, $3.25 net. Fourth Edition. 


Training School Methods for Institutional Nurses. 
i2mo of 337 pages. Cloth, $ 2.25 net. 

Home Nurse's Hand-book—12 mo of 313 pages, 
illustrated. Cloth, $2.00 net. Second Edition. 

Studies in Ethics for Nurses—i2mo of 320 pages. 

Cloth, $2.50 net. 



PRIMARY 


STUDIES FOR NURSES 


A TEXT-BOOK FOR FIRST YEAR PUPIL NURSES 


CONTAINING 

COURSES OF STUDIES IN ANATOMY. PHYSIOLOGY, 
CHEMISTRY, HYGIENE, BACTERIOLOGY, THERAPEUTICS 
AND MATERIA MEDICA, DIETETICS, AND INVALID 

COOKERY 


CHARLOTTE A. AIKENS 

n 

Formerly Director of Sibley Memorial Hospital, Washington, D. C.; formerly 
Superintendent of Iowa Methodist Hospital, Des Moines, and of Columbia 
Hospital, Pittsburg; author of “Training School Methods for Institu¬ 
tional Nurses ” “ Clinical Studies for Nurses,” “ Hospital Manage¬ 
ment,” “The Home Nurse’s Handbook of Practical Nurs¬ 
ing,” and “ Studies In Ethics for Nurses ” 


FIFTH EDITION, THOROUGHLY REVISED 


PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 

1923 





I 



Copyright, 1909, by W. B. Saunders Company. Reprinted October, 1909, April, 
1910, January, 1911, and May, 1911. Revised, reprinted, and recopyrighted 
April, 1912. Reprinted June, 1913, and March, 1914. Revised, reprinted, 
and recopyrighted June, 1915. Reprinted September, 1916, September, 

1917, July, 1918, and November, 1918. Revised, reprinted, and 
recopyrighted July, 1919. Reprinted August, 1921. Revised, / 

reprinted, and recopyrighted February, 1923 


Copyright, 1923, by W. B. Saunders Company 


MADE IN U. 8. A. 


PRESS OF 

W. B. 8AUNDER8 COMPANY 
PHILADELPHIA 


AUG 161923 

©C1A752582 








PREFACE TO FIFTH EDITION 


The first edition of this text-book contained the fol¬ 
lowing explanatory statement which also applies to the 
present edition: 

“The purpose of this book can be briefly stated. It is 
designed to assist in securing graded instruction in train¬ 
ing-schools for nurses; to promote uniformity in the 
teaching of the subjects allied to nursing which the nurse 
needs as the groundwork for a nursing education; to 
assist in eliminating non-essential instruction of a med¬ 
ical character from the nursing course, and to save time 
and labor for both pupils and teachers. It brings to¬ 
gether, in concise form, well-rounded courses of lessons in 
anatomy, physiology, hygiene, bacteriology, therapeutics 
and materia medica, dietetics and invalid cookery—those 
subjects which, with practical nursing technic, should 
constitute the first stage in a nursing education. It is 
not a text-book of practical nursing; neither is it a book 
of reference. It aims to fill the gap between the two, 
and to simplify the work of the pupil nurse’s first year.” 

The book has proved of special value in schools in 
which the class work in the first year largely depends 
upon the superintendent and head nurses. 

In this fifth edition the book has been fully revised. 
In the section on Dietetics numerous additions have been 
made. Several new tables have been added. 

New illustrations and some additional matter have 
been inserted in the section devoted to Anatomy and 
Physiology. 

Charlotte A. Aikens. 

Detroit, Michigan, 

February , 1923. < 3 































PREFACE 


In venturing to add yet another to the already numerous 
text-books for nurses, it may properly be asked, “By 
what authority do ye this thing?” The purpose of this 
book can be briefly stated. It is designed to assist in 
securing graded instruction in training-schools for nurses; 
to promote uniformity in the teaching of the subjects 
allied to nursing which the nurse needs as the groundwork 
for a nursing education; to assist in eliminating non-essen¬ 
tial instruction of a medical character from the nursing 
course, and to save time and labor for both pupils and 
teachers. It brings together, in concise form, well-rounded 
courses of lessons in anatomy, physiology, hygiene, bacte¬ 
riology, therapeutics and materia medica, dietetics and 
invalid cookery—those subjects which, with practical 
nursing technic, should constitute the first stage in a nurs¬ 
ing education. It is not a text-book of practical nursing; 
neither is it a book of reference. It aims to fill the gap 
between the two, and to simplify the work of the pupil 
nurse’s first year. 

Since the publication of “Hospital Training-school 
Methods and the Head Nurse,” a large number of letters 
have been received from nurse superintendents in different 
parts of the country, asking how they might more nearly 
bring their training-school methods into conformity with 
the practical standards outlined in that book. While 
each letter related to some supposedly peculiar difficulty, 
in the final analysis most of them hinged on the question 
of text-books. Not that there were not many very ex- 



6 


PREFACE 


cellent text-books available, but that each being devoted 
to a special subject contained hundreds of pages, presum¬ 
ably to be studied, and the time was not to be had in 
which to cover the ground laid out in each of these numer¬ 
ous text-books. A great many of the schools admitted 
to having made no attempt to teach from text-books 
anything but the theory and practice of nursing. Some 
required the pupil to own a treatise on materia medica, 
but used it mainly as a book of reference, the lecturer 
selecting from its pages here and there the subject matter 
of his lecture. On account of this “too-muchness” of 
most existing text-books, the old haphazard way of acquir¬ 
ing instruction by note-taking while a doctor lectured 
was still adhered to, though voted by all as most unsatis¬ 
factory. 

In attempting to reply to these correspondents and 
advise as to text-books which pupil nurses should be 
required to own and study, it was found that under 
present conditions if teaching from text-books was adhered 
to, the least number of books to be covered to give a well- 
rounded course was ten, and that having bought and 
studied those ten, there were still left a considerable 
number of subjects to be provided for by lecture. On 
some subjects we could make choice of upward of a 
dozen books; on others we might search in vain for 
one. These ten text-books would probably average 350 
to 400 pages each, and most of them contained a great 
deal of matter that was in no way likely to ever con¬ 
tribute to nursing efficiency. In anatomy and physiol¬ 
ogy, materia medica, and obstetrics this was particularly 
true. As books for occasional reference and general in¬ 
formation on medical subjects they were admitted to be 
valuable by all the superintendents consulted on the sub¬ 
ject, but as text-books, the contents of which were to be 
studied and digested by pupil nurses, they were voted as 
hopelessly discouraging. In many instances it was stated 
that nurses failed to grasp important practical points 
because of a too diffuse presentation of the subject. 


PREFACE 


7 


The result of numerous conferences and much corre¬ 
spondence with superintendents of hospitals and training 
schools of wide experience and with physicians who have 
lectured in hospitals for many years is the present volume. 
It will be followed by another of similar size dealing with 
the studies for senior nurses. In these text-books the 
attempt has been made to boil down material that has 
hitherto been scattered through ten or more books, and 
arrange in a form so that it can be quickly and easily 
grasped the parts of the subjects with which pupil nurses 
might profitably become familiar. It is not claimed 
that the books contain all that a nurse need ever know. 
In the years following graduation she will have ample 
time to go more deeply into all the subjects if she so 
desires. It is quite probable that even this book may 
seem too elaborate to some teachers. Others will think 
it too much condensed, but the aim throughout has been 
to strike a “happy medium” between the extremes that 
exist in methods. “Simplify,” “simplify,” has been the 
burden of the appeals that have come from those who are 
interested in the preparation of these studies. At least 
a serious attempt has been made to separate from the 
nursing course a great deal that has found its way into 
lectures, and added materially to the burdens of pupil 
nurses. 

The task has been undertaken because of a sincere 
conviction, born out of years of personal experience with 
training-school problems, that such a book was needed, 
and because of the repeated urging of personal friends 
in the hospital world. Advice and help have been freely 
sought regarding every step of its preparation, from 
physicians, nurses, and superintendents who are in active 
hospital work, and the author feels under deep obligation 
to a wide circle of friends for much kindness received 
in numerous ways connected with the undertaking. Of 
necessity, in preparing a text-book of this kind, there has 
been some overlapping of the ground covered in some of 
the text-books devoted to practical nursing. This, as 


8 


PREFACE 


will be readily recognized, has been unavoidable, since 
most of the text-books touch, lightly or otherwise, on all 
the subjects treated in this volume. 

Especial thanks are due to Miss Emma A. Anderson, 
Superintendent of New England Baptist Hospital, Boston, 
and to Miss Carrie P. Vanderwater, Principal of Grace 
Hospital Training-school for Nurses, Detroit, for valuable 
practical suggestions; to Miss Emma J. Lynch, formerly 
Matron of Iowa Methodist Hospital, Des Moines, for much 
assistance in arranging the lessons on invalid cookery; 
to Dr. Theodore McClure, Superintendent and Surgeon 
of Solvay Hospital, Detroit, to Dr. W. L. Babcock, Super¬ 
intendent of Grace Hospital, Detroit, and to Dr. W. R. 
Chittick, of Detroit, for critical reading of portions of 
the manuscript; to Dr. R. M. Phelps, Assistant Super¬ 
intendent of State Hospital for the Insane, Rochester, 
Minnesota, and to Dr. Geo. S. C. Badger, of Boston, for 
much helpful advice as to what should be included and 
excluded; and to a large number of superintendents of 
hospitals and training-schools who through their letters 
helped to furnish the incentive for the undertaking. We 
are also under obligation to the Good Health Publishing 
Company for permission to use some of the cuts of the 
invalid trays; to the W. B. Saunders Company for kindly 
furnishing many of the cuts for illustration, and to Dr. F. 
A. Washburn, Superintendent of Massachusetts General 
Hospital, Boston, for the photograph and diagrams of 
the sterilizing hopper. Believing that many lessons may 
be more quickly grasped by means of the eye than in 
any other way, a special effort has been made to secure 
suitable illustrations which might be helpful in teaching. 

It will be seen that much has been borrowed in direct 
quotation from medical writers, to whom, as far as possible, 
credit has been given and thanks are now accorded. Of 
necessity, a book of this kind must be largely compiled 
from medical works. If mention has not been made 
of all the individual sources from which encouragement 


PREFACE 9 

and help have been obtained, it is not because such assist¬ 
ance is not remembered with sincere appreciation. 

The following is a list of books which have been used as 
reference and from which information has been gleaned. 

Anatomy, Gray; Human Physiology, Furneaux; Phys¬ 
iology, Brubaker; Principles of Bacteriology, Abbott; 
Disinfection and Disinfectants, Rosenau; Hygiene and 
Public Health, Parkes; Personal Hygiene, Pyle; Materia 
Medica and Therapeutics, Bartholow; Materia Medica, 
Pharmacy, and Therapeutics, Potter; Practical Dietetics, 
Thompson; Food in Health and Disease, Yeo. Infor¬ 
mation has also been freely gleaned from government 
bulletins. 

Charlotte A. Aikens. 

Detroit. 




















' 




































CONTENTS 


PAGE 

Introduction. Suggestions to Teachers. ... 17 

Suggestions for Clinics and Demonstrations (First Year), 

26—Suggested Books of Reference for First-year Students, 

28. 

SECTION I 

ANATOMY AND PHYSIOLOGY 


CHAPTER I 

General Structure of the Human System. 29 

The Systems of the Body, 36. 

CHAPTER II 

The Human Skeleton. 42 

CHAPTER III 

Muscles and Joints. 51 

Muscles, 51—Joints or Articulations, 59. 


CHAPTER IV 

The Organs of the Abdomen and Pelvis. 68 

CHAPTER V 

Respiration and Temperature. . 81 

CHAPTER VI 

The Blood and Circulatory System . 91 


The Blood, 91—The Circulatory System, 93—Blood¬ 


vessels, 96. 

CHAPTER VII 

Digestion and Absorption . 104 

CHAPTER VIII 

The Urinary System. 112 


11 












12 


CONTENTS 


CHAPTER IX PAGE 

The Skin. 118 

Glands, 125. 

CHAPTER X 

The Nervous System. 128 

Sensations, 134—Sleep, 135. 

CHAPTER XI 

The Organs of Special Sense. 136 

CHAPTER XII 

Notes on Surgical Anatomy. 145 


SECTION II 

ELEMENTARY CHEMISTRY 
CHAPTER XIII 

Introduction. 157 

CHAPTER XIV 

A Few Fundamental Laws and Principles. 161 

CHAPTER XV 

Some Common Elements and Compounds. 165 

Experiments, 170. 

CHAPTER XVI 

Solutions, 'Acids, Bases, and Salts. 171 

Experiments, 174. 

CHAPTER XVII 

Physiologic Chemistry. 175 

Experiments, 183. 

CHAPTER XVIII 

Chemistry and Cleaning. 184 

Experiments, 186. 













CONTENTS 


13 


SECTION III 

HYGIENE 

CHAPTER XIX page 

General Hygiene . 187 

Air, 189—Water, 193—Foods, 196. 

CHAPTER XX 

General Hygiene (Continued). 199 

CHAPTER XXI 

Personal Hygiene. 209 

CHAPTER XXII 

Personal Hygiene (Continued).... 214 

SECTION IV 
BACTERIOLOGY 
CHAPTER XXIII 

Bacteriology. 221 

CHAPTER XXIV 

Infection and Immunity. 231 

CHAPTER XXV 

Surgical Cleanliness and Disinfection. 241 

Methods of Destroying Bacteria, 242. 

SECTION V 

THERAPEUTICS AND MATERIA MEDICA 
CHAPTER XXVI 

Remedial Agents. 251 

CHAPTER XXVII 

Weights and Measures and Medicinal Preparations.... 259 
Abbreviations and Symbols, 263. 












14 


CONTENTS 


CHAPTER XXVIII 

PAGE 

General Effects of Remedies and Dosage. 266 

CHAPTER XXIX 

Medicines and Their Administration. 275 

CHAPTER XXX 

Medicines and Their Administration (Continued). 282 

CHAPTER XXXI 

Evacuants and Intestinal Astringents. 295 

CHAPTER XXXII 

Emetics, Diuretics, and Diaphoretics. 303 

Emetics, 303—Diuretics, 304—Diaphoretics, 306. 

CHAPTER XXXIII 

Cardiac Stimulants and Sedatives. 308 

Physiologic Effects of Food and Alcohol, 315—Cardiac 
Sedatives, 315. 

CHAPTER XXXIV 

Remedies which Improve Digestion and Nutrition. 317 

CHAPTER XXXV 

Nerve Sedatives and Antipyretics. 321 

CHAPTER XXXVI 

Antiseptics and Disinfectants. 329 

CHAPTER XXXVII 

Miscellaneous Remedies. 335 

Common Poisons and their Antidotes, 341. 

SECTION VI 
DIETETICS 
CHAPTER XXXVIII 

The Principles of Nutrition.. 353 














CONTENTS 


15 


CHAPTER XXXIX 

PAGE 

The Principles of Nutrition (Continued). 360 

CHAPTER XL 

Principles of Cooking. 371 

Cooking of Flesh Foods, 372—Soups, 375—Cooking of 
Starchy Foods and Vegetables, 377. 

CHAPTER XLI 

Milk . 378 

CHAPTER XLI I 

Eggs and Flesh Foods. 384 

Eggs, 384—Meats, 386—Fish, 389—Cuts of Meat, 392- 
Cuts of Beef, 392—Cuts of Veal, 395—Cuts of Lamb and 
Mutton, 396—Cuts of Pork, 397. 

CHAPTER XLIII 

Vegetable Foods . 398 

Cereals, 398—Vegetables, 400—Fruits, 404—Condi¬ 
ments, 405—Beverages, 405. 

CHAPTER XLIV 

Diet for the Sick . 408 

Food Preparation and Serving, 412. 


SECTION VII 
INVALID COOKERY 
CHAPTER XLV 

Suggestions to Teachers. > . 421 

CHAPTER XLVI 

Beverages and Fluid Foods. 425 

CHAPTER XLVII 

Eggs . 431 

CHAPTER XLVIII 

Semisolid Foods. 436 

Cereals, 436. 

CHAPTER XLIX 

Soups and Purees...440 














CONTENTS 


16 

CHAPTER L 

PAGE 

Toast, Sandwiches, and Wafers. 446 

CHAPTER LI 

Meats and Fish. 455 

CHAPTER LII 

Vegetables. 463 

CHAPTER LIII 

Fruits and Desserts. 470 

CHAPTER LIV 

Salads. 482 

CHAPTER LV 

Miscellaneous Foods. 487 

SECTION VIII 

QUESTIONS FOR SELF-EXAMINATION AND REVIEW 
CHAPTER LVI 

Questions on Anatomy and Physiology. 493 

CHAPTER LVII 

Questions on Chemistry. 499 

CHAPTER LVIII 

Questions on Hygiene. 504 

CHAPTER LIX 

Questions on Bacteriology. 507 

CHAPTER LX 

Questions on Therapeutics and Materia Medica. 510 

CHAPTER LXI 

Questions on Dietetics and Invalid Cookery. 518 

' Appendix. 523 

Metric System, 523—Household Antidotes, 524—Table 
of Bones, 525—Temperature, 525—Tables for Cooking, 

526. 

Index of Drugs. 527 

Index. . 531 


















Primary Studies for Nurses 


INTRODUCTION. SUGGESTIONS TO TEACHERS 

In arranging this text-book for first-year pupil nurses, 
it seems fitting to devote the opening chapter to an 
explanation of the general plan on which the book is 
based. 

In the beginning it has been taken for granted that 
the school year consists of not less than thirty-eight 
weeks. In many schools it extends to forty or more 
weeks. It is generally admitted that the first year 
should be devoted to certain foundation studies, leaving 
the theory of the management of diseases and special 
nursing practise for a later period. The groundwork 
studies in a nursing education are general nursing tech¬ 
nic, anatomy, physiology, hygiene, bacteriology, materia 
medica, and dietetics. To this has been added in later 
years some instruction in elementary chemistry. The 
study of ethics is so intimately interwoven with every 
phase of a nurse’s work, her behavior, her life, that a 
definite place should be given to it in the schedule of every 
period of the training course. 

Nursing, so far as the science of it is concerned, is a 
combination of many other sciences. The nurse needs 
to have an elementary knowledge of anatomy and phys¬ 
iology if she is to intelligently care for the human body, 
but she has no use for a great deal that is taught on 
those subjects to medical practitioners. She must 
have some knowledge of the properties and action of the 



18 


PRIMARY STUDIES FOR NURSES 


common drugs, since she is constantly handling and 
administering them, but a comparatively short course 
in materia medica should be sufficient to teach her the 
facts about drugs which it is essential for her to know. 
She must understand dietetics and cookery to a certain 
extent, but has no need for an extended or elaborate 
course in domestic science or the chemistry of foods. 
She needs a general understanding of the principles of 
hygiene and household sanitation, but the ordinary 
nurse need not go very deeply into hospital architecture 
or sanitary science in order to be able to efficiently prac¬ 
tise the art of nursing. While at first glance the nurse's 
field of study may seem very circumscribed, it is not 
so in reality. The real essence of nursing must always 
be personal service to the sick or helpless. The nurse 
is at liberty to draw, to a certain extent, from many 
sciences, and to use for the relief of suffering the dis¬ 
coveries made in other fields of science, but she cannot 
go far into any of these sciences as a nurse before she 
becomes a trespasser on other provinces. Into whatever 
field she may go gleaning for knowledge she is certain to 
be soon recalled, to have the truth again emphasized 
that her chief work must not be along intellectual lines, 
that advancement in nursing must come by improved 
methods of practical service. 

How much to teach and how to give due proportion 
of time to each of the studies deemed necessary in the 
first year or junior period has been one of the greatest 
problems which teachers of nurses have had to wrestle 
with. However much value we may put on any of these 
subjects, we must admit that the actual doing of nursing 
duties counts for by far the most in promoting nursing 
efficiency. Granting that, the next question that arises 
is, Which of the foundation studies should come first 
and which last? It is obvious that however valuable or 
necessary the information may be to a nurse, the subjects 
cannot all come first. The desirability of having all of 
these subjects studied before entering on practical nursing 


INTRODUCTION. SUGGESTIONS TO TEACHERS 19 


duties has been and is still strongly advocated. The plan 
has some advantages and some disadvantages. In the 
great majority of schools the theoretic studies must be 
pursued while the pupil is doing actual nursing. 

The order of sequence and the proportion of time that 
may be allotted to each of the subjects treated in this 
book are matters to which much study and discussion 
have been given. Nothing is surer than that if the 
course on anatomy and physiology is spread out unduly, 
and a lesson is planned to be given every week throughout 
the pupil nurse’s first school year, as is advocated in 
some text-books and practised in some schools, nothing 
is surer than that subjects of equal or greater importance 
are crowded out, or the practical care of the sick is not 
thoroughly taught and practised. 

In arranging these studies three points have been 
especially aimed at: conciseness, adaptability to the 
practical needs of the nurse, and the avoidance of un¬ 
common technical terms as far as possible. Almost every 
paragraph will admit of amplification by the teacher, 
while at the same time the effort has been made to in¬ 
clude the points most important. The plan has been 
generally followed of presenting the broad outlines of a 
subject first before taking up minute details. When one 
considers the number of new ideas which the minds of 
first-year pupils are required to grasp even in doing ordi¬ 
nary practical duties, the necessity of condensing the 
theoretic work must be kept in mind if a student is 
expected to do efficient, thorough work. 

To know the fundamentals of a subject well is better 
than to superficially cover an elaborate and minute 
presentation of it, or to cram numerous pages before ex¬ 
amination and quickly forget. 

The knowledge of anatomy which a nurse can really 
use or apply in nursing practice can be compassed within 
comparatively small limits. 

In the studies in materia medica no attempt has been 
made to describe the appearance of drugs, and this 


20 


PRIMARY STUDIES FOR NURSES 


omission has already been commented on by friendly 
critics. It has been the author’s conviction that to 
attempt to burden a nurse with the study of the theo¬ 
retic difference in appearance between all the drugs 
mentioned in one lesson was unwise. It is suggested 
that specimens of each drug to be discussed in the lesson 
be taken to the class-room and shown to the pupils, 
and the important points and differences emphasized. It 
has also seemed unwise to require the pupils to memorize 
the different doses of a great many drugs; therefore only 
the doses of the most strongly acting drugs in common 
use have been given. It is expected that some book of 
reference on materia medica is provided by the hospital 
which the pupils can consult if they desire to know more 
of the drugs included in these studies or to go more 
deeply into the subject. Every nurse, before she goes 
out as an independent worker, should provide herself 
with a few books of reference, and especially one on 
materia medica. 

If the number of drugs included seems too few, it is 
easy to make additions. It is estimated that over two 
hundred new drugs are placed on the market each year. 
Since it is manifestly impossible for a nurse to study all 
of them, it has not been thought wise to burden her with 
a great number in any one lesson. 

For the nurse’s own safety as well as the safety of the 
patients, before a pupil is admitted to the ward as a nurse, 
a simple practical talk on germs—where they are found, 
how they are transmitted, etc.—should be given, as it is 
obvious that practical methods of prevention will need 
to be used before the theory of bacteriology can be 
taught. It is also quite plain that the patients will have 
to be fed before the lessons on dietetics are studied. 
There is no order of arrangement of studies which can be 
made which will not be open to some such objection. 
Experience has shown that these difficulties are not so 
serious in actual practise as they appear to be on paper. 
If the nurse is taught the correct methods of doing actuaJ 


INTRODUCTION. SUGGESTIONS TO TEACHERS 21 

nursing duties, and carefully supervised as she ought to be 
for the first year at least, many of these theoretic diffi¬ 
culties lose their importance. At the same time, if a two 
or three months' preparatory course is planned for before 
the pupil is admitted as a nurse, or is allowed to assume 
responsibility for the actual care of the sick, if regular 
daily classes are planned for throughout those first three 
months, the nurse acting as assistant only, in the wards 
and departments for from four to six hours each day, 
experience has proved that many advantages accrue 
both to the hospital and the pupil. 

The practical duties which nurses should be taught 
each year and the order in which they should be allowed 
to get the varied kinds of nursing experience they need 
<has been treated in some text-books, and in some schools 
a well-defined plan is carried out relating to these matters, 
the pupil gradually being promoted by change to different 
wards. In the majority of hospitals, however, a careful 
classification and separation of patients according to 
their diseases is impossible, and the order of instruction 
in practical methods is largely determined, after the first 
few months, by the circumstances which arise and the 
general ability of the nurse. 

In trying to arrive at a decision regarding the essen¬ 
tials which every nurse who calls herself a graduate should 
be taught, the following list of practical duties and 
general essentials has been arranged. It has been sub¬ 
mitted to experienced nurse superintendents and hospital 
workers and approved, and is here presented as a con¬ 
tribution toward the solution of the highly important 
practical question, How much is a hospital responsible 
for teaching? Subsequent editions will doubtless call 
for additions or changes in this list, but it is the author's 
conviction that if a nurse has been taught correct methods 
of doing the practical duties here outlined, and has been 
given a reasonable amount of theory, she is certainly 
deserving of all the rights and privileges accorded to 
hospital graduate nurses: 


22 


PRIMARY STUDIES FOR NURSES 


1. How to sweep and dust a ward; when a damp 
duster should or should not be used; arrange ventilators 
and heaters; adjust shades and bedside tables; the care of 
stoves, dish-towels, cupboards, and refrigerators. 

2. How to make a bed with or without a patient; 
adjust back-rests and pillows; change the bed with a 
helpless patient; disinfect beds, mattresses, and bedding. 

3. How to prevent bed-sores; lift and move a helpless 
patient; care for the hair; how to manage bed-pans and 
urinals; to fill and apply hot-water bottles or artificial 
heat of any kind, and the precautions to prevent burning. 

4. How to give a bath to a patient in bed; how to 
care for the mouth and teeth; how to change a gown 
with a helpless patient. 

5. How to use a clinical thermometer, count the pulse 
and respiration, mark a clinical chart, and keep a daily 
record. 

6. How to keep a bath-room in sanitary condition; 
disinfect urinals, sputum cups, bed-pans, rubber sheets, 
pus basins, and bath-tubs. 

7. How to administer medicine by mouth; to read and 
understand the abbreviations and symbols in common 
use in a hospital; the precaution to be used in handling 
all drugs; the special precaution in giving opiates and 
sedatives; the best way to give oils, powders, stimulants, 
and purgatives. 

8. How to give medicine by hypodermic injections; 
by rectum; by injection; by inhalation; by simply applying 
to the skin; how to apply ointments, and the points to 
be remembered and guarded against in the use of each. 

9. How to prepare and give a simple enema; how to 
pass the colon-tube; the precaution to be used in giving 
stimulant, sedative, and nutrient enemata; how to relieve 
an overloaded and impacted rectum; how to give a colonic 
irrigation; how to care for each utensil before and after 
use. 

10. How to save specimens of urine and other excreta 
for examination; how to pass the female catheter; how 


INTRODUCTION. SUGGESTIONS TO TEACHERS 23 


to test the specific gravity and reaction of urine; the 
simple tests for albumen and sugar; how to ascertain the 
quantity passed in a given time; the points to be observed 
and noted regarding urine in special cases; how to give a 
vaginal douche. 

11. How to receive new patients; list and care for their 
clothing and effects; care for hospital linen, blankets, and 
rubber goods. 

12. How to arrange a patient for an abdominal examina¬ 
tion; the nurse’s duties regarding general examinations 
of the whole body; how to arrange for examination of 
the chest with patients in and out of bed; how to assist 
during an examination of the spine, rectum, and genital 
organs. 

13. How to sponge to reduce fever; fill and apply 
ice-caps and coils; give injections of ice-water; apply hot 
and cold packs; the use of the bath thermometer; how to 
restrain delirious patients; general and specific precautions 
to be observed to prevent infection; the special, method 
of reducing fever preferred by the hospital physicians. 

14. How to prepare and apply hot fomentations; ice 
compresses; poultices; sinapisms; antiseptic compresses, 
blistering agents; the care of blisters; arrange for moist 
air and medicated steam; improvise a croup tent with 
provision for steam inhalations; manage the use of gargles, 
sprays, and other applications to the throat. 

15. How to prepare and apply roller bandages to head, 
arms, breast, feet, legs, abdomen, and hip; perineal 
bandages; many-tailed bandages; how to support an 
injured arm or leg. 

16. How to dress and assist a weak convalescent 
patient; to prepare and serve fluid food to invalids; the 
points to be observed in feeding milk; methods of pre¬ 
digestion; the classes of diets and amount to serve; the 
diets suitable for special diseases and conditions; special 
precautions needed during convalescence; how to weigh 
infants and adults. 

17. How to syringe ears and cleanse eyes; how to 


24 


PRIMARY STUDIES FOR NURSES 


manage eye compresses and drops; how to evert eyelids 
and make local applications; how to manage a nasal 
douche. 

18. How to disinfect a room and its contents; arrange 
for sulphur and formaldehyd fumigation with ordinary 
appliances; how to manage infectious diseases in private 
homes. 

19. How to assist the physician in aspirating and 
tapping; how to manage diaphoretic baths; dry cupping; 
lavage; enteroclysis; hypodermocylsis; spinal douches; 
Schott baths; medicated baths; Scotch douches. 

20. How to properly care for the hands in the daily 
routine; hand disinfection; sterilize ward instruments 
and cleanse after use; prepare a patient for operation; 
arrange beds for operative patients; care for patients 
immediately following operations; special observations 
to be made regarding laparotomy patients; management 
of all classes of cases requiring drainage-tubes; best 
methods of lifting and handling surgical cases. 

21. How to prepare plaster bandages; dressings for 
ward use; management of adhesive strapping; pad 
splints; manage extension apparatus; give first aid in 
fracture cases; undress accident cases; points to be 
recorded concerning accident patients. 

22. The significance of symptoms and how to make 
and record observations; how to manage a condition of 
shock; check hemorrhage in emergencies; the measures 
to be used in giving first aid to cases of poisoning by 
opium, strychnin, and carbolic acid; to prepare and 
administer emeties; how to care for burns; how to ad¬ 
minister oxygen. 

23. How to calculate the amount of drug needed in 
preparing a given quantity of disinfectant solution; to 
make all the solutions in common use; the special pre¬ 
cautions to be used in regard to each; how to prepare 
simple antiseptic mouth-washes from common materials; 
the effects on tissues of too strong solutions. 

24. How to get ready for an operation in a hospital 


INTRODUCTION. SUGGESTIONS TO TEACHERS 25 


without assistance; also in a private home; how to assist 
the surgeon in minor and major operations; the care of 
rubber gloves, ligatures, and sutures; the emergency 
remedies and applications that should be in readiness; 
the principles and methods of sterilization; the adjust¬ 
ment of patients to different positions on the operating- 
table; the after-care of the wound to prevent infection. 

25. Simple measures that can be used for the relief of 
insomnia; general massage; when not to use massage; 
massage of special parts of the body; resistive movements 
and simple gymnastic exercises. 

26. Management of common orthopedic cases; how to 
assist the orthopedic surgeon. 

27. The arrangements necessary for outdoor treatment 
of pneumonia and tuberculosis; instruction to be given 
the family and patient, and general care of tuberculosis 
patients. 

28. How to make and apply abdominal bandages; 
points to be guarded against; the making of tampons and 
vaginal applications; adjustment of pessaries; how to 
irrigate a bladder; use the vaginal speculum; remove 
and apply vaginal packing; disinfect the vagina for 
operations; the common positions used for vaginal.exam¬ 
inations and treatments; how to prevent strain of the 
perineum and sphincter; management of intra-uterine 
douches; prevention of infection of perineum after 
operation; removal of stitches; uses and management of 
vaginal suppositories and applications; general manage¬ 
ment of gynecologic patients. 

29. How to arrange an obstetric patient for examina¬ 
tion; how to assist the physician during such examinations; 
the preparation of the patient for labor; the preparation 
of bed and rooms; the appliances desirable and those 
absolutely necessary for proper management during 
parturition; the nurse's duties during a normal labor 
when the physician is present and when he is not; the 
care of the patient immediately following delivery; 
measures to prevent hemorrhage; care of asphyxiated 


26 


PRIMARY STUDIES FOR NURSES 


infants; care of premature babies; first care of the new¬ 
born; management of the eyes and cord; general care 
needed during first two weeks; how to guard against 
infection of breasts; how to treat fissured nipples and 
manage inflamed breasts; the uses of ergot in lying-in 
patients; how to give and when and when not to give 
ergot; the use and care of the breast-pump; special care 
needed during puerperium; management of abdominal 
and breast binders; proper feeding of lying-in patients; 
advice to give prospective mothers; how to prepare 
artificial food for infants; simple measures for increasing 
or decreasing flow of milk. 

30. What to do in a simple case of infantile diarrhea 
or “summer complaint” if no physician is available; 
preventive measures in relation to such diseases; the chief 
causes of constipation in children; preventive and relief 
measures; the management of a case of thrush; what to 
do in case of convulsions in children; in case of spasmodic 
croup while awaiting a doctor; management of whooping- 
cough, measles, and other common children’s diseases. 

31. The special points to be observed in the cookery 
of meats, eggs, toast, and special nourishment for invalids. 
Tray setting and attractive serving. 

32. How to improvise hospital appliances out of 
common things in emergency; how to feed obstinate or 
insane patients; how to devise occupations and enter¬ 
tainment for children and adults during convalescence. 


SUGGESTIONS FOR CLINICS AND DEMONSTRATIONS 
(FIRST YEAR ) 1 

1. Beds, bedding, bed-making, with and without a patient, man¬ 
agement of helpless patients, changing beds, bed-making for opera¬ 
tive patients, use of rubber cushions, bed-rests, cradles, arrangement 
of pillows, etc., substitutes for hospital appliances. 

2. Sweeping, dusting, preparing room for patient; disinfection 
of bedding, furniture, etc.; care of patient’s clothing in ward and 
private rooms. 

1 As recommended by American Hospital Association. 


INTRODUCTION. SUGGESTIONS TO TEACHERS 27 


3. Care of linen rooms; care of blankets, spreads, etc.; care of 
bath-rooms and appliances; disinfection of excreta and utensils. 

4. Baths: Full; sponge, to reduce temperature; foot; vapor. 

5. Administration of rectal injections for laxative, nutritive, 
stimulant, and astringent purposes; care of appliances. 

6. Vaginal douches; methods of sterilizing appliances; use and 
care of catheters; vesical douches. 

7. Hot and cold applications; making of poultices, fomentations, 
compresses; methods of application; care of hot-water bottles; uses 
and care of ice-caps and coils. 

8. Chart keeping; methods of recording bedside observations. 

9. Making of bandages: Roller, many tailed, plaster, abdominal, 
breast; making of pneumonia jackets. 

10. Methods of applying roller bandages. 

11. Methods of applying other bandages. 

12. Appliances to prepare for ward examinations and dressings. 
Sterilization. Nurses’ duties during ward dressings. 

13. Preparation of patients for operation. 

14. Preparation and care of surgical dressings, sponges, swabs, 
etc. Hand disinfection. 

15. Tray setting and food serving; feeding of helpless or delirious 
patients. Management of liquid diets. 

16. Administration of medicines: Methods of giving pills, tablets, 
capsules, powders, oils, plasters, liquids, ointments, etc. Use and 
care of medicine-droppers, minim glasses, graduate glasses, ato¬ 
mizers, inhalers, hypodermic syringes, etc. Management of inha¬ 
lations, eye drops, suppositories, etc. 

17. Care of the dead. 

18. Symptomatology: The pulse; correct methods of examining 
the pulse; volume, tension, rate, rhythm. Effects of exercise, emo¬ 
tions, baths, drugs, shock, and hemorrhage. 

19. General observation of the body. The face in disease. The 
skin. Expression of eyes, teeth, mouth, etc. 

20. Respiration: Normal; respiratory affections. Pneumonia; 
change in respiration; cough, sputum. Crisis and lysis explained 
and charts shown. 

21. Typhoid fever: General changes; face; rose spots; tempera¬ 
ture charts. Changes in temperature and pulse explained. Dan¬ 
ger signals. Methods of restraining delirious patients. Prophy¬ 
lactic measures. 

22. Specimens of excreta; nurses’ duties regarding them; impor¬ 
tance, etc. 


28 


PRIMARY STUDIES FOR NURSES 


SUGGESTED BOOKS OF REFERENCE FOR FIRST YEAR 
STUDENTS 1 

“ The Structure and Functions of the Body,” Fiske. 

“ Human Physiology,” Ritchie. 

“Human Physiology,” Furneaux. 

“ The Story of the Bacteria,” Prudden. 

“Elements of the Theory and Practice of Cookery,” Williams 
and Fisher. 

“ Materia Medica and Therapeutics,” Parker. 

“ Drugs and Solutions,” Stimson. 

“ Materia Medica for Nurses,” Blumgarten. 

“Preventable Diseases,” Woods Hutchinson. 

“Elementary and Applied Chemistry,” Irvin, Rivett, and Tat- 
lock. 

“A Text-book of Physics and Chemistry for Nurses,” Bliss and 
Olive. 

“The Principles of Human Nutrition,” Jordan. 

1 The above-mentioned set of books bear directly on the lessons 
outlined in this volume. Are simple in style and language, and 
especially suited for first-year pupils. 


30 


SECTION I 

Anatomy and Physiology 


CHAPTER I 

GENERAL STRUCTURE OF THE HUMAN SYSTEM 

Human anatomy is that branch of science which has 
for its object the investigation or study of the structure 
of the body. 

Human physiology is that department of science which 
has for its object the study of the uses or functions of 
the different parts of the body in health. 

The study of anatomy is usually carried on by using 
the dead body as subject matter. The science of phys¬ 
iology requires that it be studied on the living subject. 

Body Surfaces.—In viewing the body as a whole, anat¬ 
omists observe the rule of placing the body with its face 
toward the observer, erect, and with the palms of the 
hands turned forward. 

The ventral surface is the name given to the front of 
the body, and the dorsal to the back. 

The median line is the term used to indicate an imaginary 
line drawn from the top of the head through the middle 
of the body. 

The human body has been compared to a house, of 
which the bones constitute the framework. This frame¬ 
work serves the double purpose of supporting and afford¬ 
ing protection to the softer parts of the body. 

An examination of the body will show that it is made 
up of a number of distinct structures, each of which has 
a definite duty or function to perform. The term “ organ 
is apolied to these distinct structures, as, for instance, the 

29 



30 


ANATOMY AND PHYSIOLOGY 


tongue is known as the organ of speech; the eye, as the 
organ of vision; the stomach, as an organ of digestion, etc. 

An organ, therefore, may be defined as any part of the 
human body to which a definite work or function in the 
general activity of the body has been assigned. 

A common division of the body is into head, trunk, and 
extremities. The skull or cranium is a large, hollow, 
bony structure composed of a number of smaller bones 
which enclose the brain. 

Connecting with the cavity of the skull at its base is 
the spinal column, formed by the union of the bones of 
the spine. 

The spinal or vertebral column is the central portion 
of the skeleton to which all the bones included in the 
trunk are related. Extending from the brain down 
through the spinal cavity or enclosure is the spinal cord, 
protected by membranes and by a fluid known as the 
cerebrospinal fluid. 

Cavities.—The body has in it two great cavities—“a 
dorsal or back cavity and Sr ventral or front cavity. In 
these two cavities are found most of the organs of the 
body. The cavity in the skull and the canal in the back¬ 
bone or spinal column, taken together, are the dorsal 
cavity. In this cavity lie the great centers of the nervous 
system, the brain and spinal cord.” (Ritchie.) 

The trunk is commonly divided into two main parts: 
the thorax or chest and the abdomen. In the upper 
division, or thorax, are contained the heart, lungs, and 
other smaller organs. In the abdomen are found the 
stomach, intestines, liver, pancreas, spleen, kidneys, 
and bladder. 

These divisions are separated from each other by a 
muscular partition known as the diaphragm. The upper 
division is commonly spoken of as the thoracic cavity 
and the lower as the abdominal cavity. The ventral 
cavity includes the thoracic and abdominal cavities. 
Occasionally, for convenience of description, the lower 
part of the abdominal cavity is spoken of as the pelvic 
cavity. 


GENERAL STRUCTURE OF THE HUMAN SYSTEM 31 

A summary of the main cavities of the body might be 
made as follows: 

1. The cranial cavity, the hollow within the skull 
which contains the brain. 

2. The spinal canal, which contains the spinal cord. 

3. The orbital cavity, which contains the eye. 

4. The nasal cavity, which accommodates the structures 
which form the nose. 

5. The buccal cavity or mouth contains the tongue, 
teeth, and salivary glands. 

6. The thoracic cavity contains the heart, lungs, trachea 
or windpipe, esophagus or gullet, and the structures sur¬ 
rounding them. 

The diaphragm is the dome-shaped partition between 
the thoracic and abdominal cavities. 

7. The abdominal cavity contains the stomach, spleen, 
pancreas, liver, gall-bladder, kidneys in back portion, 
behind the peritoneum. 

8. The pelvic cavity, which contains the bladder, rec¬ 
tum, and some of the reproductive organs. 

The extremities are in two divisions: the upper extremi¬ 
ties or the arms, and the lower extremities or the legs. 

The bony framework of the body is covered exter¬ 
nally by the skin. The cavities are lined internally with 
a membrane known as the mucous membrane., This 
mucous membrane lines all the cavities and organs which 
communicate with the outer world, such as the membrane 
found inside the mouth. 

Muscles. —Stretched over the skeleton or framework 
of the body are the muscles which move it. The muscles 
form the greater part of the flesh which rounds out the 
body. They number more than five hundred and con¬ 
stitute almost half the body weight. The muscles have 
several different functions, which will be spoken of later. 

Nerves. —In order that all parts of the body may 
work together there must be a ruling or controlling force. 
In the body this controlling force is the nervous system, 


32 


ANATOMY AND PHYSIOLOGY 


which governs all the organs of the body and causes them 
to work in harmony. 



t> —Diagrammatic longitudinal section of the body V V 

Bodies of the vertebrae which divide the body into the dorsal and ventral 
cavities; a, a, the dorsal cavity; C. p', the abdominal and thoracic 
divisions of the ventral cavity, separated from each other by a trans¬ 
verse muscular partition the diaphragm d; B, the brain; Sp. c., spinal 
cord; e, the esophagus; S, stomach, from which continues the intestine 
to the opening at the posterior portion of the body; l, iiver; p, pancreas; 
fc, kidney; o, bladder; l, lungs; h, heart (Brubaker). 


Nutritive Fluids.—Circulating through the body and 
intimately concerned in the upbuilding of its parts are 














GENERAL STRUCTURE OF THE HUMAN SYSTEM 33 


the nutritive fluids of the body—the blood, the lymph, 
and the chyle. The blood has been termed “the vital 
fluid” because it is essential to life. It is carried through 
the body in tubes known as arteries, veins, and capillaries, 
and is kept in motion by the action of the heart. 

Structural Elements.—Having viewed the body as a 
whole and noted its framework, its main divisions and 
parts, a closer investigation will show that the different 
organs or parts are composed of different materials com¬ 
monly termed tissues, and that these tissues have certain 
distinguishing characteristics. The tissues are composed 
of minute parts called cells. 

Life. —All life comes from a cell which has various 
properties, by means of which life is carried on—such as 
the power to appropriate nourishment from surrounding 
matter, the power to reject matter that is unsuitable, the 
power to grow and reproduce. 

Life is defined as “a series of definite and successive 
changes which take place within an individual or plant 
without destroying its identity. Life is the continuous 
adjustment of internal to external relations. No life 
can come into being except as emanating from some 
preceding life. This applies to plant life as well as to 
animals and man. Each animal and plant produces its 
kind and that only. No individual life is identical in 
form, shape, and detail with the life from which it sprang, 
or with any other previous life. It has only ‘general 
resemblance.’ There are always individual differences.” 

A cell is the unit of life, the beginning of all life and 
growth, whether in plants or animals. A cell has been 
defined as a portion of transparent jelly-like material 
called protoplasm. It is surrounded by a thin wall and 
“resembles a small sac filled with clear, half-liquid sub¬ 
stance. In each cell is a nucleus which is a denser portion 
of the protoplasm. Both the nucleus and the less dense 
material around it take in food and grow; both of them 
are alive. Taken together they are the protoplasm, the 
living substance of the cell.” (Ritchie.) 

3 


34 


ANATOMY AND PHYSIOLOGY 


These minute bodies of protoplasm, known as cells, 
appropriate nutriment from surrounding materials and 
reject materials for which they have no use. They may 
convert this food or nutriment into new tissues and store 



Fig. 2. —Cell division. The nucleus of the cell divides and part 
goes to each end of the cell. A wall is formed across the cell, dividing 
it into two parts, each of which is a cell. All new cells are formed in this 
way. (From Ritchie’s “Human Physiology,” World Book Co., publishers.) 


it up in the form of new cells, or may give it out in the 
various secretions and excretions of the body. 

The cell has also the ability to divide into two cells, 
each cell having a nucleus, each being complete and hav- 



Fig. 3.—Taste cells: a, Cover- 
cells; b, taste-cells proper. 



Fig. 4. —Cylindric ciliated cells: 
a, Cilia; b, cell-body; c, nucleus. 


ing the same power as the parent cell. This process is 
known as reproduction. 

The history of all forms of life may be summed up as 
follows; development, growth, reproduction, decay, and 













GENERAL STRUCTURE OF THE HUMAN SYSTEM. 35 


death. All through life new cells are coming into existence 
and old cells are dying and being cast off. 



Fig. 5. —Olfactory Fig. 6. —Diagram of a typical cell: A, Cell- 

cells. wall; B, cell-body; C, nucleus; E, nucleolus; F, 

centrosome; a, spongioplasm; b, hyaloplasm; c, 
metaplasm or microsomes; d, exoplasm; e, nuclear 
membrane; /, nuclear network or chromatin fila¬ 
ments ; g, nuclear matrix; h, nodal enlargements or 
net knots (Leroy). 

From cells the various tissues of the body are formed. 
In all tissue there is a certain amount of lifeless matter 
besides the cells, known as the intercellular substance, 
which the cells have produced at different stages of growth. 



jr IG . 7 ._Epithelial cells from various localities: a, Prickle-cell from skin; 

b, goblet-cells (Leroy). 

This intercellular substance acts as a form of cement and 
helps to hold the cells together. 






36 


ANATOMY AND PHYSIOLOGY 


THE SYSTEMS OF THE BODY 

It has been found that the human body is made up of 
these minute elements or cells, which exist and multiply 
up to a certain point, independently of the cells which 
surround them. Animal life is the combined result of 
the lives of these cells which compose the living body. 
The organs of the body are made up of certain cells sepa¬ 
rated into groups which have each their special function to 
perform in maintaining life. 

The united action of the cells from which the muscles 
are formed produce the movements of the body. The 
cells from which the liver is formed, when acting har¬ 
moniously, have for their special function the removal 
of certain impurities from the blood and the formation 
of certain fluids of the body. Other cells of a different 
type when collected form the brain and result in the 
production of thought and intelligence, and from others 
are formed the nerves which convey impressions to and 
fro between the brain and the external world. On the 
cells of the stomach we depend for the gastric digestion 
of our food. The cells of the lungs take in oxygen from 
the air. The red blood-corpuscles, or blood-cells, carry 
the oxygen through the body. Through these varied types 
of cells acting in harmony, each performing its peculiar 
function properly, the human system is maintained in a 
condition of health. 

In studying the body it has been found convenient to 
arrange it in what are termed systems or groups of organs 
which work together for the performance of some special 
function or object. The chief systems are: 

The osseous or bony system. 

The muscular system. 

The respiratory or breathing system. 

The circulatory system. 

The nervous system. 

The digestive system. 

The absorptive system. 

The excretory or purifying system. 

The reproductive system. 


GENERAL STRUCTURE OF THE HUMAN SYSTEM 37 


The Tissues.—In the construction of the various 
organs there are elementary parts or web-like structures 
known as tissues. These tissues may be divided into 
two main classes: those which maintain the activities 
of the body and those which are useful in supporting, 



holding together, and protecting the more important 
vital structures. In the first class would be placed 
muscular and nerve tissue; in the second would be placed 
connective tissue, adipose tissue, osseous tissue, carti¬ 
laginous tissue, epithelial tissue, and gland tissue. 

Connective tissue (also called fibrous tissue) constitutes 






38 


ANATOMY AND PHYSIOLOGY 


a considerable portion of the body, binding together the 
several elements composing the different organs, and 
serving as a supporting framework for the various parts. 

Osseous tissue forms the bony framework around which 
the soft tissues arrange themselves. It forms a large 
part of the substance of the teeth. 

Muscular tissue is of two kinds, and is used to form 
the greater part of the soft structures of the body. 

Cartilaginous tissue in adults is found chiefly at the 
ends of bones where a certain amount of elasticity is 
required. 

Areolar or cellular tissue resembles fibrous tissue. 

Nerve tissue is the most important of all the tissues of 
the body, as from it emanates thought, sensation, motion, 
and vital action. 

Epithelial tissue is composed of cells united by a cement 
substance so arranged as to form the skin or covering 
for the body. 

Adipose tissue is really a form of connective tissue in 
which the fat cells occupy the spaces between the fibers. 
It may be found in nearly all parts of the body in vary¬ 
ing quantities, but it is most abundant just beneath the 
skin, where it serves as a protection from the cold. 

Gland tissue is composed of cells which have the 
power to form some special substance out of the blood. 

The osseous or bony system is composed of a large 
number of bones connected so as to form joints or articu¬ 
lations. It is bound together firmly at the joints by strong 
fibrous bands known as ligaments. 

Cartilage or gristle is an elastic tissue, softer and more 
pliable than bone. It is used in certain parts of the 
body instead of bone where a yielding substance is 
required. 

At birth an infant has no bones, strictly speaking, for 
bones begin as cartilage. The process of changing 
cartilage into bone is said to go on for the first twenty 
years of life at least, the original flexible cartilage becom- 
ing gradually stiffened by the deposit of bone-making ele¬ 
ments among its cells. 


GENERAL STRUCTURE OF THE HUMAN SYSTEM 39 


The muscular system is composed of the flesh or 
muscle which surrounds the bones; and the muscles, in 
turn, are made up of fibers or collections of muscle cells. 
Through this system motion in the body is made possible. 
The muscles also contribute to the rounding out of 
various parts of the body. 

The respiratory or breathing system consists of the 
lungs, the trachea or windpipe, and larynx, together 
with the diaphragm and chest walls. Its function in 
the body is to introduce oxygen into the blood and 
eliminate from the system certain injurious products. 

The circulatory system is composed of the heart and 
blood-vessels, including arteries, veins, and capillaries. 
Its function is the distribution of blood to all parts of 
the body. 

The nervous system has two main divisions: the 
cerebrospinal system and the sympathetic system. 

The cerebrospinal system, consists of the brain and its 
nerves and the spinal cord and its nerves. 

The sympathetic system , which is also termed the 
ganglionic system, consists of double chains of ganglia 
or knots of nerve matter situated on either side of the 
vertebral column. The chief functions of the nervous 
system are to receive and transmit impressions, impulses, 
or messages to and from the outer world by means of the 
organs of the five senses. The skin is the organ of touch; 
the eye, of sight; the nose, of smell; the ear, of hearing, 
and the tongue, the organ of taste. Through its con¬ 
nection with the muscles, the nervous system controls 
the motions of the body. The nerves and muscles are 
sometimes classed together as the nervomuscular appara¬ 
tus, or the apparatus whose function it is to produce 
motion. 

The digestive system consists of the mouth, pharynx, 
esophagus, stomach and intestines, and the organs known 
as glands connected with them, which prepare the diges¬ 
tive materials. The function of this system is the com¬ 
plete digestion of the food needed for the body. 


40 


ANATOMY AND PHYSIOLOGY 


The absorptive system consists of capillary blood¬ 
vessels and other vessels, known as lymphatics. The 
chief function of this system is to convey the new material 
derived from food supplies into the blood, whereby it is 
distributed throughout the body to repair waste and 
make growth possible. 

The excretory or purifying system has for its function 
the separation of impurities from the blood and the re¬ 
moval of waste matter from the body. The organs chiefly 
concerned in this work are the lungs, the skin, and the 
kidneys. To these are sometimes added the liver and 
bowels. The lungs, the skin, the urinary apparatus (which 
consists of the kidneys, the bladder, and the ureters or 
tubes which connect them), and the bowels are said to 
constitute the sewer system of the body. 

The reproductive system has for its function the 
perpetuation of the race or species to which an individual 
belongs. The organs which constitute this system 
differ in the two sexes and need not be considered in a 
general description of the human structure. 

The blood is a fluid tissue. It is-the most important 
fluid of the body and is estimated to constitute about 
one-eighth of the body weight. The amount is said to 
be from 16 to 18 pounds in an individual of average size 
and general development. 

Glands form an important part of the mechanism of the 
body. 

A gland has been defined as “ a collection of cells which 
can form a secretion or an excretion.” 

Excreting glands separate from a part substances which 
have no further part to play in the bodily functions. 

Secreting glands form from the blood substances which 
did not exist in it before which the body needs. 

Some of the glands perform both the secretory and ex¬ 
cretory functions. Most of them are provided with ducts 
which convey the secretions or excretions to other parts. 

Ductless glands are believed to manufacture substances 
that are absorbed by the body tissues. The spleen is the 
largest of the ductless glands. 


GENERAL STRUCTURE OF THE HUMAN SYSTEM 41 


Waste and Repair.—In health each particular organ 
has the power to use new material to repair itself, and 
the human machine may be said to work properly so long 
as this power of repair is maintained and sufficient new 
material is supplied. 

The human body is frequently compared to an engine 
constructed for work, needing to be constantly supplied 
with material from which energy or force or power to 
work is produced. The human machine, however, 
differs in this respect from the artificial, in that whether 
it is at work or at rest the process of waste, wear, or 
disintegration goes on. Its machinery cannot stop while 
life lasts. Every thought, every act, or motion causes 
waste of some of the tissues. The material for the 
renewal of the different elements of the body that are 
constantly being lost must be supplied through foods. 
So long as the process of waste and repair are about 
equal, the balance of health is maintained. 

World Materials .—The tangible materials of the world 
are made up of minerals, plants or vegetables, and 
animals. Minerals have neither life nor growth. Plants 
live, grow, and die, but have no power of voluntary 
motion and no intelligence. In the animal kingdom 
there is life, growth, motion, intelligence, and will. 

Chemical Composition of the Body.—Of the seventy 
or more elementary substances known to chemists, about 
fifteen are found in the human body. The four chief 
elements are oxygen, carbon, hydrogen, and nitrogen. 
Besides these, calcium or lime, phosphorus, sulphur, 
potassium, iron, and a few other ingredients are found 
in small quantities. These are termed “ elementary sub¬ 
stances.” 

“An elementary substance or element is a substance 
which consists of only one kind of matter, and, therefore, 
cannot be divided into two or more simpler substances. 

A compound substance is one which consists of two or 
more elements chemically combined, and which may be 
analyzed and split up into those elements. 


42 


ANATOMY AND PHYSIOLOGY 


The chemical elements of which the body is composed 
may be divided into two main .classes: organic and 
inorganic. This same classification applies to the foods 
which maintain the body. 

Organic substances are vegetable or animal substances 
which are prone to putrefaction. 

Inorganic substances are minerals, of which the principal 
are water, common salt, potash, lime, and iron. 

Life cannot be maintained on mineral substances 
alone nor on organic substances. Food substances must 
contain a mixture of these. 


CHAPTER II 
THE HUMAN SKELETON 

The skeleton is the framework of the body. It has three 
chief functions: 

1. To support the body. 

2. To protect parts of the body that are easily injured. 

3. To provide a system of levers by means.of which 
movements of the body may be made. 

The human skeleton is made up of 200 bones, which 
are arranged as follows: In the skull, 22; in the trunk, 52; 
in the upper extremities, 64; in the lower extremities, 62. 
In addition there are four bones in each ear called ossicles 
or “ little bones.” Some bones which are distinct in 
infancy become fused in the adult. These bones are the 
framework of the body, and also protect the organs which 
they enclose. 1 

1 The spinal or vertebral column is composed of a 
number of small bones jointed so as to form a long 
bony tube known as the spinal canal. This tube con¬ 
tains and protects that part of the nervous system 
called the spinal cord. The spinal column forms a kind 
x For Table of Bones, see Appendix, page 525. 



THE HUMAN SKELETON 


43 


of axis with which the various parts of the skeleton are 
connected. The head rests on the first of the spinal ver¬ 
tebra, known as the atlas; the second vertebra is the 
axis. These two are so connected as to allow a con¬ 
siderable degree of movement to the head. The vertebrae 



F IG . 9.—The skeleton (Lewis). 


are united by pads of elastic cartilage. In early life ' 
there are thirty-three distinct bones in the vertebral 
column, some of which are finally fused, leaving, in adult 
life, twenty-six bones. 









44 


ANATOMY AND PHYSIOLOGY 


y cervical 
f vertebra# 




The bones of the trunk assist in forming a cavity which 
has three divisions—the thorax, abdomen, and pelvis. 

The framework for the thorax 
or chest is formed by the ribs 
(twelve pairs), which connect be¬ 
hind with the dorsal vertebrae. 
The first seven pairs are called 
the true ribs and the lower five 
false ribs. The upper seven pairs 
connect with the sternum or 
breast bone. The eighth, ninth, 
and tenth ribs are connected each 
to the one above by cartilage. 
The eleventh and twelfth are 
known as floating ribs. These 
connect with the spinal column, 
but do not connect with anything 
in front. The spaces between 
the ribs are known as intercostal 
spaces. 

The sternum or breast bone is 

a flat narrow bone about six 
inches long located in the median 
line in the front of the chest. 
The first seven pairs of ribs, 
known as the true ribs, connect 
with the sternum by means of the 
costal cartilages. 

The clavicle or collar-bone 
joins the upper part of the ster¬ 
num or breast bone in front and 
the scapula or shoulder-blade in 
the back. 

The scapula or shoulder-blade 

is a large, flat, triangular-shaped 



»Sacrum 


Fig. 10.—The spinal column 
* (Church and Peterson). 


bone, located between the second and eighth rib on the 
back part of the thorax. It has a shallow cavity into which 
the head of the humerus, the bone of the upper arm, 






THE HUMAN SKELETON 


45 


fits. The glenoid cavity is the name given to this cavity, 
in which articulation with the humerus takes place. The 
joint formed at this point allows greater freedom of motion 
than any other joint in the body. 

The upper arm has but one bone—the humerus. 

The lower part of the arm, known as the forearm, has 
two bones—the radius and the ulna—the latter of which 
is the larger. 



Fig. 11.—Thorax, anterior view (Ingals). 


A perfect hinge-joint is formed with these bones and 
the humerus. The lower end of the ulna does not enter 
into the wrist-joint, but articulates with the radius. 

The wrist is composed of eight small bones, known 
as the carpal bones. The wrist-joint is formed by the 
articulation of these small bones with the lower end of 
the radius and ulna. 

The hand is composed of five metacarpal bones, which 
form the palm, and the fourteen phalanges. Three of 
the phalanges are in each finger and two in the thumb. 





46 


ANATOMY AND PHYSIOLOGY 


i 



The pelvis is composed of four bones, two ossa innomi- 
nata, the sacrum, and coccyx. The ossa innominata, 






THE HUMAN SKELETON 


47 


commonly called the pelvic or hip-bones, are also called 
innominate bones, meaning a bone without a name. 
In infancy the os innominatum is made up of three bones, 
the ilium, which forms the wide flaring top of the pelvis; 
the ischium, and the pubis, the bone which forms the 
front of the pelvis. At the joint where these three bones 
meet, a deep cup-like cavity, called the acetabulum, 
is formed. The back of the pelvic wall is formed by the 
sacrum, upon the upper articulating surface of which 
the spinal column rests. The sacrum in infancy is five 
separate bones, which later are fused into one. The 
coccyx, which is the extreme lower point of the spinal 
column, is formed of four small bones. The junction of 
the pubic bone in front is called the symphysis pubis. 

The pelvis is divided into two parts. The upper broad 
shallow part is known as the false pelvis, and the lower 
as the true. There are certain differences between the 
male and female pelvis. The female pelvis is wide at 
the pubic arches, lighter, shallower, and more roomy 
than that of the male. 

The lower extremities are arranged somewhat similar 
to the upper. The femur or thigh bone has at its upper 
point a rounded head which fits into the acetabulum of 
the pelvis, forming a ball-and-socket joint. Two bony 
projections below the head of the femur are known as 
the trochanters. 

The tibia or shin-bone and the fibula are the bones 
of the leg. The tibia is the larger and articulates with 
the femur, forming the knee-joint. The patella, or 
knee-cap, serves as a protection for the knee-joint. “The 
patella is more often broken by muscular violence than is 
any other bone in the body.” (Treves.) 

The foot is composed of the tarsal or ankle-bones, 
the metatarsal or instep-bones, and the fourteen phalanges 
of the toes, arranged like those of the hands. The foot 
is arched in form, powerful ligaments being fixed to 
prevent its falling flat. It is said that sixty-two bones 
are more or less necessary for the act of walking. 


48 


ANATOMY AND PHYSIOLOGY 



The skull is composed of the cranium, the large hollow 
bony case which surrounds the brain, and the face. 
There are eight bones in the cranium and fourteen in the 
face. Some of these bones are the result of two or more 
bones being fused, which in infancy were distinct. At 
birth, the bones of the cranium are not perfectly developed 
and not firmly jointed. Between them are spaces occu¬ 
pied by cartilage or membrane. These spaces are called 


Fig. 13—Front view of the skull (Sobotta and McMurrich). 

the anterior and posterior fontanels. The posterior or 
occipital fontanel is a triangular soft spot on the top of 
the head which closes in a few months. The anterior 



THE HUMAN SKELETON 


49 


or frontal fontanel remains till near the end of the second 
year. 

In the composition of bone mineral matter forms 
about two parts to one of animal matter. The chief 
mineral ingredient is lime, which produces hardness. 
Gelatin is the principal animal ingredient, and contributes 
to flexibility and elasticity. In children, the bones 
contain less mineral matter and are, therefore, softer, 
while in adults there is less animal matter, and, there¬ 
fore, less elasticity. 

Cartilage is the gristle or white elastic substance at¬ 
tached to certain bone surfaces. It is of several varieties, 
all of which serve as a flexible connecting material between 
bones. Cartilage is always found where strength com¬ 
bined with a certain degree of elasticity is required. It 
readily yields to extension or pressure, yet quickly re¬ 
sumes its original shape. The elasticity of the chest 
walls is a familiar example of the uses of cartilage. In the 
aged the bones are brittle, fracture easily, and heal 
slowly with great difficulty. 

The term green-stick fracture is applied to the condition 
in which the bone of a child bends. Some of the outer 
fibers may break, but not the complete bone. 

Rachitis or rickets is used to describe the condition very 
common among insufficiently nourished children in which 
there is a lack of mineral substance. The bones are 
flexible, bend easily, and often become permanently mis¬ 
shapen. 

The Periosteum. —All bones are covered with a strong 
fibrous membrane known as periosteum, which supplies 
nutrition to the bone. If, by any means, the periosteum 
becomes injured, so that it can no longer nourish the 
bone, necrosis or death of bone results. 

The joints or articulations of bones are surrounded by 
a smooth elastic cartilage. The cartilage is supplied 
with a membrane called the synovial membrane. This 
membrane secretes the synovia, a fluid which serves to 
lubricate the joints. 


50 


ANATOMY AND PHYSIOLOGY 


Bones in general are divided into four classes: long, 
as the femur or humerus; short, as the wrist bones; 
flat, as in the top of the skull; and irregular, as the ver¬ 
tebrae. There are certain surface markings of bone to 
which special names have been assigned: 

A 'process is a prolongation or prominence of a part—a 
slender projecting point. 

The alveolar process is that border of a jawbone which 
contains the tooth-sockets. 

The odontoid process is a tooth-like point of the axis 
which ascends and unites with the atlas. 

The mastoid process is the conic projection at the base 
of the mastoid portion of the temporal bone. 

The olecranon is a curved process of the ulna at the 
elbow. 

A foramen is an opening or hole through a bone. 

A spine is a long or sharp projection. 

A fossa is a depression or furrow. 

A tuberosity is a bony protuberance. 

A crest is a surmounting part or a prominent border. 

A sinus is a recess, cavity, or hollow space. It is further 
defined as an air-cavity in one of the cranial bones. 

Note. —For Table of Bones of Skeleton, see Appendix. 


MUSCLES AND JOINTS 


51 


CHAPTER III 


MUSCLES AND JOINTS 


THE MUSCLES 


The skeleton supports the body. Over the framework 
of bones the muscles are stretched. The muscles move 
the body. This is their first and chief function. Muscles 
help to enclose the cavities of the body and protect the 
internal organs. Another function of muscles is to as- 



Fig. 14.—Muscles of the right side of the head and neck: 1, Frontalis; 
2, superior auricular; 3, posterior auricular; 4, orbicularis palpebrarum; 
5, pyramidalis nasi; 6, compressor naris; 7, levator labii superioris alaeque 
nasi; 8, levator labii superioris; 9, zygomaticus major; 10, orbicularis oris; 
11, depressor labii inferioris; 12, depressor anguli oris; 13, anterior belly 
of digastric; 14, mylohyoid; 15, hyoglossus; 16, stylohyoid; 17, posterior 
belly of digastric; 18, the masseter; 19, sternohyoid; 20, anterior belly 
of omohyoid; 21, thyrohyoid; 22, 23, lower and middle constrictors of 
pharynx; 24, sternomastoid; 25, 26, splenius; 27, levator scapulae; 28, an¬ 
terior scalenus; 29, posterior belly of omohyoid; 30, middle and posterior 
scalenus; 31, trapezius (Dorland’s Dictionary). 


sist the ligaments to bind the skeleton together at the 
joints. Most of the muscles stretch across a joint, and 
the large muscles add greatly to the strength of the joint. 


52 


ANATOMY AND PHYSIOLOGY 


The muscular tissue which covers the bone, and which 
is the immediate cause of motion in the various parts, 
derives its power from certain cells. Muscle cells are 



*5.-—Muscles of the trunk from before (left side, superficial; right 
side, deep): 1, Pectoralismajor; 2, deltoid; 3, portion of latissimus dorsi; 
4, serratus magnus; 5, subclavius; 6, the pectoralis, sternocostal portion - 
7, serratus magnus; 12, rectus abdominis; 13, internal oblique; 14, ex¬ 
ternal oblique; 15, abdominal aponeurosis and tendinous intersections 
of rectus abdominis; 16, over symphysis pubis; 17, linea semilunaris; 
18, gluteus medius; 19, tensor vaginae femoris; 20, rectus femoris - 21 
sartorius; 22, femoral part of iliopsoas; 23, pectineus; 24, abductor lon’gus’; 
25, gracilis (Dorland’s Dictionary). 


longer than the average body cell, and are often spoken 
of as muscle-fibers. They have the power to contract, 
to draw together, and become shorter and thicker. 












MUSCLES AND JOINTS 53 

This causes the joint to bend over which the muscle 
passes. 

There are two classes of muscles—voluntary and in¬ 
voluntary. 



Fig. 16. —Muscles of the trunk from behind (left side, superficial; right 
side, deep): 1, Sternomastoid; 2, splenius; 3, trapezius; 4, latissimus 
dorsi; 5, infraspinatus; 6, teres minor; 7, teres major; 8, deltoid; 9, ex¬ 
ternal oblique of abdomen; 10, gluteus medius; 11, gluteus maximus; 12, 
levator anguli scapulae; 13, rhomboideus minor; 14, rhomboideus major; 
15, part of longissimus dorsi; 16, tendons of insertion of iliocostalis; 17, 
supraspinatus; 18, infraspinatus; 19, teres minor; 20, teres major; 21, 
serratus magnus; 22, 22', upper and lower part of serratus posticus in¬ 
ferior; 23, internal oblique; 24, gluteus medius; 25, pyriformis and supe¬ 
rior and inferior gemelli; 26, 26 , portions of obturator internus; 27, ten¬ 
don of obturator internus; 28, quadratus femoris (Dorland’s Dictionary). 


Voluntary muscles are under the control of the will. 
These are often termed striped or striated muscles. 






54 


ANATOMY AND PHYSIOLOGY 


Through these we have the power of voluntary motion 
and locomotion. Voluntary muscles form the greater 
part of the muscular system. 

Involuntary muscles , or unstriped or non-striated mus- 




Fig. 18. 

Fig. 17.—Superficial muscles of shoulder and arm (from before): 1, 
Pectoralis major; 2, deltoid; 3, biceps brachii; 4, brachialis anticus; 5, 
triceps; 6, pronator radii teres; 7, flexor carpi radialis; 8, palmaris longus; 
9, flexor carpi ulnaris; 10, supinator longus; 11, extensor ossis metacarpi 
pollicis; 12, extensor brevis pollicis; 13, flexor sublimis digitorum; 14, 
flexor longus pollicis; 15, flexor profundus digitorum; 16, palmaris brevis; 
17, abductor pollicis (Dorland’s Dictionary). 

Fig. 18.—Superficial muscles of shoulder and arm (from behind): 1, 
Trapezius; 2, deltoid; 3, rhomboideus major; 4, infraspinatus; 5, teres 
minor; 6, teres major; 7, latissimus dorsi; 8, triceps; 9, anconeus; 10, 
brachialis anticus; 11, supinator longus; 12, extensor carpi radialis longior; 
13, extensor carpi radialis brevior; 14, extensor communis digitorum; 15, 
extensor carpi ulnaris; 16, flexor carpi ulnaris; 17, extensor ossis meta¬ 
carpi pollicis; 18, extensor brevis pollicis; 19, tendon of extensor longus 
pollicis (Dorland’s Dictionary). 

cles, are found in the walls of blood-vessels, the heart, 
stomach, and internal organs. 

Most of the voluntary muscles are connected with 
bones and are generally arranged in pairs, one muscle 
contracting to move the bone and its opposite bringing 
it back to its former position. 










MUSCLES AND JOINTS 


55 


Flexors are muscles which bend the limbs. 

Extensors are muscles which straighten the limbs. 

Tendons are masses of white fibrous tissue which 
attach muscles to bone. 

The terms origin and insertion are applied to the 
attachments of muscles to bone at opposite ends, but 
the origin of but a few muscles, comparatively, is abso¬ 
lutely fixed. 

Hollow muscles are those which enclose cavities, and 
are usually involuntary. The heart and stomach are 
examples of this class. 

Attachment of the muscles to the skeleton is accomplished 
in different ways, but chiefly by means of tendons. Mus 
cles are also attached to cartilage, ligament, and skin. 
The muscle-fibers come together as they approach their 
tendinous extremity, and gradually blend with the fibers 
and cells of the tendons, which, in turn, insert their fibers 
into the bones. 

Fascia is a fibrinous membrane covering muscles. An 
aponeurotic fascia is any fascia that serves to keep a 
muscle in its place and to connect muscles and tendons. 
The fascia not only envelops and binds down a muscle, 
but separates muscles into groups. Thus we find cervical 
fascia, pelvic fascia, thoracic fascia, etc. 

Some Uses of Tendons. —Certain parts of the body need 
much greater strength than others, and to be able to make 
a great number of movements without being large and 
heavy, as, for example, the hands. In such parts of the 
body the muscles are placed at some distance and joined 
to the bones by tendons. The muscles that move the 
fingers are on the forearm and only slender tendons run 
to the hands. 

The abdominal muscles when they contract compress 
the organs of the abdomen and narrow the cavity. In 
this motion they are assisted by the diaphragm. These 
muscles are able to exercise important influence in empty¬ 
ing the bowel and bladder, in the act of vomiting, and also 
during childbirth. 


56 


ANATOMY AND PHYSIOLOGY 


“These muscles connect the ribs and sternum with 
the rim of the pelvis, and prevent the upper part of the 
trunk from being drawn over backward by the long 



Fig. 19. Fig. 20. Fig. 21. 

Fig. 19.—Muscles of the inner side of thigh and interior of pelvis: 1, 
Iliacus; 2, psoas magnus; 3, obturator internus; 4, pyriformis; 5, erector 
spinae; 6, gluteus maximus; 7, sartorius; 8, adductor longus; 9, gracilis; 
10, adductor magnus; 11, semimembranosus; 12, semitendinosus; 13, 
rectus femoris; 14, vastus internus (Dorland’s Dictionary). 

Fig. 20.—Superficial muscles of the leg from inner side: 1, Vastus in¬ 
ternus; 2, sartorius; 3, gracilis; 4, semitendinosus; 5, semimembranosus; 

6, inner head of gastrocnemius; 7, soleus; 8, tendon of plantaris; 9, tendon 
of tibialis posticus; 10, flexor longus digitorum; 11, flexor longus hallucis; 
12, tibialis anticus; 13, abductor hallucis (Dorland’s Dictionary). 

Fig. 21.—Superficial muscles of front of thigh: 1, Insertion of external 
oblicjue into iliac crest; 2, aponeurosis of external oblique; 3, external ab¬ 
dominal ring; 4, gluteus medius; 5, tensor vaginae femoris; 6, sartorius; 

7, iliopsoas; 8, pectineus; 9, adductor longus; 10, gracilis; 11, adductor 
magnus; 12, vastus externus; 13, rectus femoris; 14, vastus internus; 15, 
biceps flexor cruris (Dorland’s Dictionary). 


muscles of the back. The abdominal muscles also hold 
the internal organs in place, and by forcing back against 













MUSCLES AND JOINTS 


57 


the dorsal wall of the abdominal cavity, support the spinal 
column in front of the lumbar region.” (Ritchie.) 

“The erect position of the human body is maintained 
by the combined influence of a large number of muscles 



Fig. 22. Fig. 23. 

Fig. 22.—Muscles of leg and foot (from before): 1, Tendon of rectus 
femoris; 2, vastus internus; 3, vastus externus; 4, sartorius; 5, iliotibial 
band; 6, inner head of gastrocnemius; 7, inner part of soleus; 8, tibialis 
anticus; 9, extensor proprius hallucis; 10, extensor longus digitorum; 11, 
peroneus longus; 12, peroneus brevis; 13, peroneus tertius; 14, origin of 
extensor brevis digitorum (Dorland’s Dictionary). 

Fig. 23.—Superficial muscles of leg (from behind): 1, Vastus externus; 
2, biceps flexor cruris; 3, semitendinosus; 4, semimembranosus; 5, graci¬ 
lis; 6, sartorius; 7, 8, outer and inner head of gastrocnemius; 9, plan- 
taris; 10, soleus; 11, peroneus longus; 12, peroneus brevis; 13, flexor 
longus digitorum; 14, tibialis posticus; 15, lower fibers of flexor longus 
hallucis (Dorland’s Dictionary). 


acting at the same time. The whole weight of the body 
rests on the arches of the feet, and the body may be 
supported in any position providing the center of gravity 
is situated vertically over any point in the space enclosed 
by the feet. ,, (Furneaux.) 







58 


ANATOMY AND PHYSIOLOGY 


The voluntary muscles of the body number over 
three hundred. There are only a few of these which a 
nurse will ever have to distinguish 
in ordinary nursing practise. 

The occipital and frontal muscles 
are the chief muscles of the head. 
They are usually spoken of as one 
muscle—the occipitofrontalis. 

The intercostal muscles occupy the 
spaces between the ribs. 

The pectoral muscles form the 
bulk of the muscular wall of the 
chest in front. They are known as 
the pectoralis major and the pec- 
toralis minor. 

The diaphragm is the large mus¬ 
cle separating the thorax from the 
abdomen. It is sometimes called the 
muscle of respiration. In shape it 
resembles a dome. It serves as the 
roof of the abdomen and the floor 
of the thorax. In it are three open¬ 
ings for the passage of the blood¬ 
vessels and the esophagus. 

The external oblique muscle is the 
large muscle which covers the front 
of the abdomen. Other muscles of 
the abdomen are the internal ob¬ 
lique, transversalis, and rectus. 

The biceps is a long muscle which helps to form the 
anterior surface of the arm. 



Fig. 24. —Superficial 
muscles of liip and thigh 
(from behind): 1, Glu¬ 
teus medius; 2, gluteus 
maximus; 3, vastus ex- 
ternus; 4, biceps flexor 
cruris; 5, semitendino- 
sus; 6, semimembrano¬ 
sus; 7, gracilis; 8, sarto- 
rius; 9, adductor magnus; 
10, 11, gastrocnemius; 
12, origin of plantaris 
(Dorland’s Dictionary). 


. The triceps is its opposite on the back of the arm. 

The deltoid is a triangular muscle covering the shoulder- 
joint. 

The erector spince, situated on each side of the spinal 
column, is attached by its continuations to all the ver¬ 
tebrae and assists in maintaining the erect position. 





MUSCLES AND JOINTS 


59 


The psoas muscles are heavy muscles attached along 
the spinal column in the lumbar region. They brace the 
spinal column on the front of the lumbar curve, preventing 
too great a forward curvature at this point, and when they 
contract they lift the thigh. 

The gluteal muscles form the fleshy masses of the but¬ 
tocks. 

The posterior femoral or hamstring muscles (three in 
number) cover the back of the thigh. 

The quadriceps covers the front of the thigh. It is 
the principal anterior femoral muscle. 

The gastrocnemius muscle forms the calf of the leg. 

The tendo Achillis is the strongest tendon of the 
body. It connects the calf of the leg with the heel 
bone. 

Abductors are muscles which draw away from the me¬ 
dian line. 

Adductors are muscles which draw toward the median 
line. 

A ligament is a band of fibrous tissue binding bones 
together. 

A capsule (in anatomy) is a membranous sac enclosing 
a part. 


JOINTS OR ARTICULATIONS 

The bones of the skeleton are connected by means of 
joints or articulations. 

Joints are of two kinds: 

Immovable or fixed joints are sometimes called sutures. 
An example of this class is the skull. 

Movable joints are joints capable of motion. In mov¬ 
able and in some of the fixed joints the following struc¬ 
tures enter into their formation: bone, cartilage, ligament, 
synovial sac, fluid, and capsule. Surrounding the joints 
of the extremities and some other joints are tendons, 
muscles, arteries, veins, lymphatics, nerves, fascia, and 
skin. 

Movements in joints are gliding, angular, rotation, and 


60 


ANATOMY AND PHYSIOLOGY 


circumduction, the latter of which is a continuous circu¬ 
lar movement of the limb. 

Gliding 'joints are spoken of as gliding when the articu¬ 
lating surfaces are nearly flat, permitting a slight gliding 
movement, as in the ankle or wrist. 

Ball-and-socket joints are freely movable. They con¬ 
sist of a rounded head which rotates in a hollow socket, 
as the hip-joints and shoulder-joints. 

Hinge-joints permit of flexion and extension. The 



Fig.' 25.—The craniovertebral ligaments: A, Posterior view: a, Poste¬ 
rior occipito-atlantal ligament; b, posterior atlanto-axial ligament; c, cap¬ 
sular ligament; d, posterior surface of occipital bone; e, posterior arch 
of atlas; /, lamina of axis. B, Anterior view: a, Lateral occipito-atlantal 
ligament; b, anterior occipito-atlantal ligament; c, anterior atlanto-axiai 
ligament; d, capsular ligament; e, atlas; /, axis (Dorland’s Dictionary). 

elbow-joint is an illustration of this class; also the 
knee-joint, one of the most complicated joints in the 
body. 






MUSCLES AND JOINTS 


61 



Fig. 26.—Ligaments of the wrist-joint: A, Anterior aspect: a, Radius; 
b, ulna; c, anterior radio-ulnar ligament; d, internal lateral ligament; e, 
anterior ligaments;/, external lateral ligaments, q, first metacarpal bone; 
h, palmar ligaments; i, palmar carpal ligaments; j, capsular ligament. 
B, Dorsal aspect: a, Ulna; 6, radius; c, posterior radio-ulnar ligaments; 
d, posterior ligament (Dorland’s Dictionary). 



Fig. 27.—Ligaments of the elbow-joint: A, Anterior aspect: a, Hume¬ 
rus; b, ulna; c, radius; d, internal lateral ligament; e, anterior ligament; 
f, orbicular ligament; g, oblique ligament. B, Posterior aspect: a, Hu¬ 
merus; b, radius; c, ulna; d, external lateral ligament; e, orbicular liga¬ 
ment: /, posterior ligament (Dorland’s Dictionary). 


Pivot joints permit of rotation of one bone around 
another which remains stationary, as in the articulation 




62 


ANATOMY AND PHYSIOLOGY 


of the atlas and axis where the head joins the spinal 
column. 



Fig. 28. —Ligaments of the shoulder: a, Superior acromioclavicular 
ligament; b, coraco-acromial ligament- c, coracohumeral ligament; d, 
transverse ligament; e, coracoclavicular ligament; /, anterior costo- 
sternal ligament; g, interclavicular ligament; h, anterior sternoclavicular 
ligament; i, costoclavicular ligament; j, capsular ligament (Borland’s Dic¬ 
tionary). 



Fig. 29. Ligaments of the foot: A, Dorsal aspect: a, Astragalus; b, 
calcaneo-astragaloid ligaments; c, dorsal ligaments or tarsus; d, tarso¬ 
metatarsal ligaments; e, transverse ligaments B, Plantar aspect: a 
Os calcis; b, greater calcaneocuboid ligament, c, deep calcaneocuboid 
ligament; d inferior tarsometatarsal ligament; e, tarsometatarsal liga¬ 
ments (Dorland s Dictionary). 


“In these joints the articulating surfaces of the bones 
are covered with a thin layer of articular cartilage. This 







MUSCLES AND JOINTS 


63 


cartilage is again covered with a membrane, known as 
the synovial membrane” (Furneaux). 


A B 



F IG . 30.—Ligaments of the knee-joint: A, Anterior aspect: a, Femur, 
b, ligamentum patellae; c, internal lateral ligament; d, external lateral 
ligament. B, Posterior aspect: a, Femur; b, posterior ligament; c, internal 
lateral ligament; d, external lateral ligament; e, posterior ligament of per¬ 
oneotibial articulation; /, interosseous ligament (Dorland’s Dictionary). 

Cartilage is of two kinds: temporary, which is converted 
into bone in adults; permanent, which is not converted 
into bone. 



Fi G . 31.—Ligaments of the ankle-joint: A, Internal aspect: a, Tibia; 
b, internal lateral ligament. B, external aspect: a, Tibia; 6, anterior 
ligament; c, external lateral ligament (Dorland’s Dictionary). 


Cartilage in joints forms a strong yet yielding frame¬ 
work. It deepens the sockets of the joints; covers the 


64 


ANATOMY AND PHYSIOLOGY 


articulating surface of bone, reducing friction; acts as 
protective in lessening injury from shocks and blows. 

Nervous Control of Muscles. —All muscular tissue is 
abundantly supplied with nerves, which convey impulses 
to the muscles from the central nervous system. Motor 
nerves have for their special function the control of mus¬ 
cular contraction and the producing of motion. “From 
the brain or spinal cord a nerve goes to every voluntary 
muscle in the body, and a branch of a nerve-fiber goes to 
each muscle cell. When you wish to make a certain 
movement the commands pass through the nerves ..to 



c 


Fjg. 32.—Front view of the pelvis, with its ligaments: a, Anterior 
sacro-ihac ligament; b, iliofemoral ligament; c, obturator membrane; 
d, symphysis pubis; e, sacrosciatic ligament (Dorland). 

the proper muscles, the muscle cells contract, and the 
movement is made.” (Ritchie.) 

Fatigue, as a rule, occurs as a result of prolonged mus¬ 
cular contraction. This produces waste substances 
which accumulate and act as poisons, and also results in 
excessive loss of material needed for maintaining the tone 




MUSCLES AND JOINTS 


65 


of the tissues. During rest periods the blood should be 
able to carry fatigue poisons to the organs which excrete 
them and also convey nutritive material from the digestive 
system to rebuild muscular tissue. 

Special Membranes.—A membrane is a thin layer of 
tissue which covers a surface or divides a space or organ. 
Membranes have many distinguishing characteristics, but 
they may be broadly classified as follows: 

1. Mucous. 

2. Serous. 

3. Cutaneous. 

4. Synovial. 

Mucous membranes constitute the lining of passages 
and cavities which have an opening to the exterior of the 
body. Their surfaces are covered by mucus, a viscid 
watery secretion from the mucous glands, which performs 
important functions in the body. 

The functions of mucous membranes are, first, protec¬ 
tion for the passages of the body which connect with the 
outer world. Foreign substances which would otherwise 
gain access to the body are prevented by the mucus, and 
are forced out with and by it. 

They are abundantly supplied with blood-vessels, and 
assist in the important functions of circulation and ab¬ 
sorption. This membrane lines the mouth, the alimen¬ 
tary canal, the air-passages, the kidneys, bladder, and the 
entire urinary tract. It also forms the lining of the vagina 
and uterus in the female. 

Serous membranes are found lining organs and cavities 
of the body which do not have an opening to the exterior. 
These include the pleura, the membrane which covers the 
lungs and lines the chest; the pericardium, which covers 
the heart; the peritoneum, which lines the abdominal 
cavity. It is also found lining the cavities within the 
skull and spinal cord, and the internal coat of heart, blood¬ 
vessels, and lymphatics closely resembles the serous mem¬ 
brane in its structure. The chief function of the serous 
5 


66 


ANATOMY AND PHYSIOLOGY 


FRONTAL 

SINUSES 

DUCTS OF 

LACHRYMAL GLAND8 
UPPER LIDS 

EYES 

LOWER UD8 
TEAR DUCTS 


ETHMOIDAL SINUSES 



ANAL 

CANAL 


Diagram of the gastropulmonary mucous membrane, 
continuity of all its parts. (From Gerrish, “Text-Book o 
Lea & Febiger, publishers.) 


showing the 
Anatomy,” 
















MUSCLES AND JOINTS 


67 



Diagram of the male genito-urinary mucous membrane, showing con¬ 
tinuity of all its parts. (From Gerrish, “Text-Book of Anatomy,” Lea & 
Febiger, publishers.) 












68 


ANATOMY AND PHYSIOLOGY 


membrane is protection. It secretes a serum which serves 
to lubricate the surfaces and thereby lessens friction. 

The cutaneous membrane covers the body, and will be 
discussed in the chapter relating to the skin. 

Synovial membranes are sometimes spoken of as serous 
membranes. Their function is the same, and they do 
not open to the exterior. They differ in their structure, in 
the character of the fluid they secrete, and are always 
associated with bones, muscles, and joints. 

The fluid secreted by the synovial membranes is known 
as the synovia. 


CHAPTER IV 


THE ORGANS OF THE ABDOMEN AND PELVIS 

The organs of the abdomen include— 

The esophagus (lower part). 

The stomach. 

The intestines. 

The liver. 

The pancreas. 

The spleen. 

The kidneys* 


The organs of the pelvis are— 


Male Pelvis. 

The rectum. 

The bladder. 

The prostate gland. 


Female Pelvis. 
The rectum. 

The bladder. 

The uterus. 

The ovaries. 

The Fallopian tubes. 
The vagina. 



THE ORGANS OF THE ABDOMEN AND PELVIS 69 


The esophagus extends from the mouth or pharynx, 
a cavity or sac at the back of the mouth, to the stomach. 
It is the narrowest part of the 
food passage or alimentary canal, 
and is composed of thick mus¬ 
cular fibers, the inner coat of 
which pass around it in a circle. 

These fibers contract on food as 
it enters the tube and force it into 
the stomach. It passes through 
the diaphragm and is widened 
where it joins the stomach. 

The stomach is a muscular sac 
measuring from 10 to 12 inches 
from right to left. In shape it 
resembles somewhat a curved 
flask, with the larger end toward 
the left. Its average capacity 
is about 5 pints. The larger end 
is called the cardiac extremity 
and the narrower end the pyloric 
extremity. The opening from the 
esophagus into the stomach is 
called the cardiac orifice, and the 
opening into the intestines, the 
pylorus. The right surface on 
the upper side comes in contact 
with the liver. 

The stomach walls have four distinct coats. The outer 



Fig. 33. —The alimentary 
canal (Stoney). 


Or peritoneal coat is a layer of the peritoneum, a mem¬ 
brane which lines the inner surface of the abdomen and 
covers the organs. The next coat is muscular; the next 
is composed of areolar tissue, and the lining of mucous 
membrane. 

The mucous membrane of the stomach is composed 
largely of very small glands which secrete the mucus 
needed to keep the surface moist and the gastric fluid 





70 


ANATOMY AND PHYSIOLOGY 


needed for digestion. It is estimated that from 10 to 
20 pints of gastric fluid are secreted by the gastric glands 
in twenty-four hours. 



Fig. 34. —The stomach (Morrow). 


The stomach is the chief digestive organ of the body. 

The gastric fluid secreted by the gastric or peptic 
glands consists of water, pepsin, common salt and other 
salts, and hydrochloric acid. It— 

Dissolves nitrogenous foods. 

Dissolves the albuminous walls of fat-cells and the 
tissues that connect them, thus liberating fats for diges¬ 
tion. 

Converts albuminoids into peptones. 

Converts foods into chyme. 

Coagulates certain albuminous -substances, such as 
the casein of milk. 

Acts as an antiseptic. 

The gastric fluid has no action on fats or starchy foods. 

The intestines occupy a large portion of the abdominal 
cavity. These, like the stomach, have four layers in the 
wall; are from 25 to 30 feet long in the adult, and are 
divided into small and large intestines. 

The small intestine is about 20 feet in length. The 


THE ORGANS OF THE ABDOMEN AND PELVIS 71 


upper part, which joins the pylorus, is called the duodenum 
—about 10 inches in length. The other two divisions 
of the small intestine are known as the jejunum and the 
ileum. 

The large intestine is about 6 feet long and is divided 
into the cecum, the colon, and the rectum. Between 



Fig. 35.— A, The ileocecal valve (Campbell). 


the small and large intestines is a valve called the ileo¬ 
cecal valve, which allows the contents of the small 
intestine to pass downward, but resists passage from the 
large intestine upward. 

The large intestine enlarges abruptly and joins the 
ileum at right angles. Close to the junction on the 
cecum side is a small fleshy tube closed at its free end, 
which is termed the vermiform appendix. 

The colon has thr§e divisions—the ascending, trans¬ 
verse, and descending colon. 

The mucous or inner coat of the bowel, like that of the 
stomach, is composed largely of glands. These glands 
secrete mucus and certain fluids for digestion. To cer¬ 
tain groups of these glands the term “Peyer’s patches” 
has been given. 

Peristalsis.—A continual worm-like motion of the in¬ 
testine is kept up, to which the term “peristalsis” has 
been given. By means of this peristaltic action the 






72 


ANATOMY AND PHYSIOLOGY 


contents are kept in motion, mixed with the digestive 
fluids, and carried along. 

The liver is a large organ, weighing from 3 to 5 pounds, 
located on the right of the abdomen. It is the largest 



Fig. 36. —Portion of the wall of the small intestine, laid open to show 
the valvulae conniventes (Brinton). 

gland of the body and performs both the secretory and 
excretory function. It is in two lobes or parts, the right 
lobe touching the kidney and the left crossing the median 
line and partly covering the stomach. It is a complex 



Fig. 37.—Mucous membrane of the jejunum, highly magnified 
(schematic): 1, 1, Intestinal villi; 2, 2, closed or solitary follicles; 3, 3, 
orifices of the follicles of Lieberkuhn (Testut). 

organ, having several different functions in the processes 
of the body. These functions are not yet wholly under¬ 
stood, but it is known that it— 

Secretes bile. 








THE ORGANS OF THE ABDOMEN AND PELVIS 


73 


Prepares glycogen. 

Assists in the formation of urea and allied products. 

Modifies the composition of the blood as it passes 
through it. 

It has been said that “the liver acts as a sort of siding, 
into which are switched trains of both venous and arterial 
blood for a transfer of their freight.” Its most important 
function is the secretion of bile. From 30 to 40 ounces 
of bile are secreted daily. 

Bile is both a secretion and an excretion; it contains 
new constituents found nowhere else in the body, which 



Fig. 38.—The liver, seen from below: 1, Inferior vena cava; 2, gall-blad¬ 
der (Morrow). 


play an important part in digestion; and also contains 
waste ingredients which are carried through a duct into 
the intestinal tract to be eliminated. It stimulates 
peristalsis and acts as a disinfectant to the bowel. 

Glycogen is a substance resembling sugar and starch 
in composition. It contributes to the heat of the body. 

The gall-bladder is a pear-shaped sac situated on the 
under surface of the liver. It acts as a reservoir for the 





74 


ANATOMY AND PHYSIOLOGY 


bile, which is carried from it into the duodenum by 
means of the common bile-duct. 

The pancreas, commonly known as sweetbread, is a 
gland which lies behind the stomach, and extends from 
the duodenum to the spleen. Its function is the prepara¬ 
tion of the pancreatic fluid, one of the digestive juices. 
This fluid is carried into the duodenum by the pancreatic 
duct. 

The spleen or milt is a ductless gland which is believed 
to assist in producing some of the constituents of the 
blood. It is situated close to the cardiac end of the 
stomach, directly beneath the diaphragm. 



Fig. 39. —Pancreas dissected to show d.p., pancreatic duct; d.p.a., 
accessory duct; d.ch., bile-duct. Duodenum laid open to show p.m., 
papilla major; p.l., papilla minor; spZ., spleen; k., kidney; j., jejunum; 
m.v., mesenteric vessels; c.a., celiac axis (Robson and Moynihan). 


The kidneys are two bean-shaped organs situated in 
the back part of the abdomen, one on each side of the 
spinal column. They are organs of excretion, their func¬ 
tion being to separate from the blood certain poisonous 
substances which have accumulated during its circulation 
through the body. 

The ureters are two tubes leading from the kidneys 




THE ORGANS OF THE ABDOMEN AND PELVIS 75 

to the bladder. Their function is to convey the matter 
secreted by the kidneys, in the form of urine, to the 
bladder. 

The adrenals or suprarenal capsules are two small 
flattened triangular-shaped bodies which rest on the 
upper part of the kidneys. The secretion from these 
glands performs a most important function in maintain¬ 
ing the normal tone of the body, and in the regulation of 
the blood-supply. Too much or too little activity in these 
small glands may produce disastrous results on the 
general health. (See pages 125, 126.) 

The bladder is a strong membranous and muscular 
sac situated in the pelvis. It is a reservoir for the tem¬ 
porary reception of the urine and is composed of four 
coats. Its opening is controlled by a muscular band 
called a sphincter. The tube which conveys the urine 
from the bladder outward is the urethra. The outer 
opening of the urethra is called the meatus urinarius. 

The peritoneum is a membrane which lines the abdo¬ 
men and folds around all the organs. The part which 
connects the intestine to the abdominal wall is called the 
mesentery; that which is connected with the stomach, the 
omentum. The peritoneum is a closed sac, the interior 
of which is termed the peritoneal cavity. 

The organs contained in the abdomen, when classed 
together, are termed the abdominal viscera. 

The abdominal region is divided as follows: 

The epigastric region is the region over the stomach. 

The umbilical region is the middle region, and includes 
a portion of the abdomen immediately above and below 
the umbilicus. 

The hypogastric region is the lower part of the abdo¬ 
men. 

The rectum is the lower part of the large intestine. 
Its length is from 4 to 5 inches. It follows the curve 
of the pelvic wall formed by the sacrum and coccyx. 
It joins the colon at that portion of the colon known as 


76 


ANATOMY AND PHYSIOLOGY 


the sigmoid flexure, where an abrupt turn or bend is 
made in the course of the bowel. 

The anal canal is a term applied to the last 1J inches 
of the rectum, where it bends slightly to pass the point 
of the coccyx. 



Fig. 40.—Position of the thoracic and abdominal organs, front view 
(Morrow). 

The anus is the opening into the rectum. It is con¬ 
trolled by two muscles, known as the internal and external 
sphincters. 

The Female Pelvis and Its Organs.—The female pelvis 
differs from the male, being shallower and more roomy. 







THE ORGANS OF THE ABDOMEN AND PELVIS 77 


Within the true pelvis are the female generative organs— 
the uterus, ovaries, Fallopian tubes, and the vagina, with 
which, for purposes of study, may be grouped the external 
genitals or vulva. 



Fig. 41.—Position of the thoracic and abdominal organs, rear view 
(Morrow). 

The uterus is a hollow, muscular, pear-shaped organ— 
from 2\ to 3 inches in length and weighing about 2 ounces. 
It is located in the center of the pelvis, between the blad¬ 
der and rectum, and is held in its place by ligaments. It 
receives the ovum, nourishes it after fertilization occurs, 












78 


ANATOMY AND PHYSIOLOGY 


and ultimately expels the fetus. It also furnishes the 
menstrual flow. 

The lining is of mucous membrane. It is covered with 
“a microscopic down which has the function of automatic 



Fig. 42. —Section showing bladder, uterus, and rectum. Red line indi¬ 
cates the peritoneum (De Lee). 


waving, thus moving any object lying on the surface.” 
(De Lee.) 

Arranged perpendicular to its surface are numerous 
tubular cells or uterine glands. 

The broad ligaments are a part of the peritoneum, and 
extend from the sides of the uterus to the walls of the 
pelvis. 

The round ligaments are cords of muscle from 4 to 5 




THE ORGANS OF THE ABDOMEN AND PELVIS 79 


inches long, extending downward and forward from the 
upper part of the organ until they become lost in the 
muscular tissues connected with the pubes. 

The uterus is divided, for convenience of description, 
into three parts—the fundus, which is the broad upper 
portion of the organ, the body, and the cervix or neck. 
The opening in the cervix is called the os. 



Figs. 43, 44. —The uterus, ovary, and Fallopian tube (Macfarlane). 

The ovaries are small oval-shaped bodies, located one 
on either side of the uterus and connected with the broad 
ligament. Their length is about inches. They con¬ 
tain the ova or eggs, which are contributed by the female 
for the propagation of the species. 

The Fallopian tubes are ducts or tubes which convey 



80 


ANATOMY AND PHYSIOLOGY 


/ 


the ova from the ovaries to the uterus. They open at 
one end into the uterus and, at the other, spread out in 
fringe-like processes known as the fimbriated extremity or 
fimbriae. One of the fimbria is longer than the others, 
and is indirectly connected with the ovary by a fold of 
the peritoneum. 

The vagina is a canal-like passage lying between the 
bladder and rectum. It is attached to the uterus at the 
middle of the cervix and terminates at the vulva. 

The 'perineum, is the name given to the fleshy wall that 
lies between the vagina and the rectum and anus. It is 
subject to great strain during childbirth, resulting in fre¬ 
quent lacerations, sometimes extending so deeply that the 
anus and rectum are torn. 


RESPIRATION AND TEMPERATURE 


81 


CHAPTER V 


RESPIRATION AND TEMPERATURE 

Respiration has been defined as the inspiration and 
expiration of air or “the function by which oxygen is 
absorbed into the blood and carbonic acid exhaled. 
It is a part of the general nutritive process of the body, 
the blood, and respiratory 
organs, constituting the 
media by which the inter¬ 
change of gases is accom¬ 
plished.^ 

11 The object of respira¬ 
tion is to take oxygen into 
the body and to give off 
carbon dioxid from the 
body.” (Ritchie.) 

Inspiration is the tak¬ 
ing in of air to the lungs 
as seen when the chest 
rises. 

Expiration is the forc¬ 
ing of air out of the lungs 
as seen when the chest 
falls. The processes of 
inspiration and expiration 
together constitute res¬ 
piration. 

The respiratory organs 
are the larynx, trachea, 
and lungs. The mouth 
and nose are spoken of as 
the upper air-passages. 

The framework of the chest and the muscles used in 
breathing are sometimes included in describing the res¬ 
piratory system. 

6 



Fig. 45. —Interior of the larynx: 
1, Epiglottis; 2, vocal cord; 3, cavity 
of the trachea (after Testut). 







82 


ANATOMY AND PHYSIOLOGY 


The diaphragm is an important muscle in the respiratory- 
process. It is defined as a thin, dome-shaped muscle, with 
a center of connective tissue. The stomach and liver fit 
into the hollow of its lower surface. (See Fig. 47, p. 83.) 
In inspiration the diaphragm is drawn downward. The 
bottom of the chest cavity sinks; the ribs and sternum are 
drawn upward and widen outward. The drawing away 
of the chest walls and diaphragm from the lungs leaves a 



Fig. 46. —The air follows the path indicated by the blue arrows, and 
the food follows the path indicated by the red arrows. (From Ritchie’s 
“Human Physiology,” World Book Company, publishers.) 

vacuum. The air is drawn into and expands the lungs. 
In expiration the diaphragm is forced upward. 

The pharynx is a small funnel-shaped cavity behind 
the mouth. 

The uvula, a portion of the soft palate, is found in 
front of the nasal openings separating the pharynx from 
the mouth. During swallowing it is pushed back over 
the nasal openings, and prevents food or water from en¬ 
tering the nose. 









RESPIRATION AND TEMPERATURE 


83 


The tonsils, two in number, are found in the side walls 
of the pharynx. They are frequently the seat of active 
inflammation. 

The larynx is the organ of voice, the upper part of the 
wind-pipe. 



Fig. 47.—The diaphragm, inferior surface: 1, 2, 3, Central cordiform 
tendon; 4, 5, crura; 6, internal arcuate ligament; 7, external arcuate liga¬ 
ment; 8, aortic opening; 9, esophageal; 10, opening for vena cava (Leidy). 

The epiglottis is a flap-like structure in front of and 
above the opening to the larynx. 

The trachea or wind-pipe is a tube which passes down¬ 
ward from the throat into the thorax or chest. It con¬ 
sists of rings of cartilage connected by fibrous tissue. 
The lower part of the trachea divides into two branches, 
called bronchi, which lead to the lungs. They are differ¬ 
entiated as the right bronchus and the left bronchus. 

The bronchi subdivide again and again until their 
branches reach every part of the lungs. In the trachea 
and bronchial tubes the mucous membrane which lines 
them consists of peculiar cone-shaped cells, the large 
ends of which are covered with very fine hairs. These 
hairs or hair-like processes of certain cells are called 




84 


ANATOMY AND PHYSIOLOGY 


cilia. They are constantly in motion in one direction, 
thus maintaining a constant current of the mucous 
secretion toward the mouth. Protection from dust is 
thus provided for the lungs, the dust being arrested in 
the mucus and carried to the mouth, where it is ex¬ 
pelled. 



Fig. 48.—Larvnx, trachea, and bronchi (Morrow). 


The lungs occupy the larger portion of the thoracic 
cavity. They are two large spongy organs extending 
from the root of the neck about lj inches above the 
collar-bone, to the diaphragm, which forms the floor of 
the thoracic cavity, or about to the sixth and seventh ribs. 
The lungs are unequal in size, the base of the right lung 


RESPIRATION AND TEMPERATURE 


85 


being considerably curved by the bulging upward of the 
liver. The base of the left lung is also concave, or has a 
hollow curve, though not so deep, because of the upward 
projection of the stomach, the left lobe of the liver, and 
the spleen. 

The right lung is larger, broader, nearly 2 inches shorter 
than the left, and weighs about 2 ounces more. It is 



Innominate. 


artery 


Larynx 


Right common 
carotid artery 
Subclavian 
arteries 


Arch of aorta- 
Right lung- 

Superior vena, 
cava 
Right auricle 


Trachea 


Subclavian 


arteries 


Left lung 


Pulmonary 

artery 

Heart 

Coronary 

artery 


Fig. 49.—Relation of lungs to other thoracic organs (Ingals). 


divided by deep fissures into three lobes, and the left 
into two. The lungs are covered by a double membrane, 
called the pleura. 

4 The pleurae are two thin, double-walled sacs. The 
outer layer of a pleura is attached to the chest wall and 
diaphragm, and stretches as a partition across the thoracic 
cavity from top to bottom. The inner layer encloses the 
lung. This layer of the pleura is very delicate and forms 
a thin coat over the surface of the lung. The surfaces of 
the pleurae are kept moist with a thin yellowish liquid. 


















86 


ANATOMY AND PHYSIOLOGY 


This prevents friction when the two layers of the pleura 
move on each other in breathing. 

“In pleurisy, or inflammation of the pleura, considerable 
quantities of fluid may collect between the layers of the 
pleurae.” (Ritchie.) 

The pulmonary tissue is made up largely of small cells 
and capillaries, together with the bronchial tubes. Bands 
of yellow elastic tissue connect these several elements. 


Fig. 50.—Diagram of pleural cavities: a, Ribs; b, costal pleura; c, pleural 
cavities; d, lungs; e, diaphragm; f, pulmonic pleura (McCombs). 



These cells are arranged in small groups, called lobules, 
and attached to the termination of the bronchioles, 
the term given to the termination of the bronchial tubes 
in the air cells. Underneath this thin membranous 
lining of the air cells is a close network of capillaries so 
small that it is said but a single blood corpuscle can pass 
through a vessel at once. It is estimated that there are 
about eighteen million of these air cells. Through this 







RESPIRATION AND TEMPERATURE 


87 


thin film of tissue, which is exposed to the air on both 
sides, the whole amount of the blood of the body flows 
three times a minute. For the aeration and purification 
of the blood and ventilation of the body it is estimated 
that about 12,000 quarts of air each day are necessary, 
though the entire volume of air passing in and out of the 
lungs in twenty-four hours is subject to great variation. 



Fig. 51. —The pleurae. (From Ritchie’s “Human Physiology,” World 
Book Company, publishers.) 


The normal respiration is about in the ratio of 1 to 4 
of the heart-beats. In inspiration the thorax is enlarged 
by the lowering of the diaphragm, the elevation and 
distention of the ribs, and the distention of the elastic 
tissue of the air cells. In expiration this process is 
reversed. 

The power of chest expansion may be diminished by 
compression or by lack of use of the muscles involved, 
just as want of exercise in other muscles of the body will 














88 


ANATOMY AND PHYSIOLOGY 


result in a weakening and wasting of muscular tissue. 
The lung tissue also may lose its elasticity by habitual 
neglect or obstruction of normal expansion. 

Air is a combination of numerous gases, of which the 
chief are oxygen and nitrogen. Other gases in minute 
quantities are found in it, of which the most important 
is carbonic acid or carbon dioxid. A certain proportion 
of watery vapor is also contained in it. 

Oxygen is essential to animal life. The nitrogen serves 
the purpose of diluting the oxygen, which in its pure 
state, if inhaled for any length of time, would create 
disturbance in the system. Carbonic acid is found in 
the air as the result of decomposition of animal and 
vegetable substances. It is essential to plant life, but 
in large quantities is destructive to human life. The 
watery vapor of the air moistens the oxygen and enables 
the lungs to utilize it more readily. 

Tidal air , or the breathing volume of air, is that which 
passes in and out of the lungs with each respiration. 

Complemental air is that which can be taken into the 
lungs by a forced inspiration. 

Residual air is that portion which remains in the chest 
and cannot be expelled after the most forcible efforts 
at expiration. 

The quantity of oxygen consumed in a day is subject 
to great variation. It is increased by exercise, digestion, 
and a low temperature, and decreased by opposite 
conditions. 

The exhalation of carbonic acid is increased by active 
muscular exercise, by age, and by certain foods and 
beverages. It is decreased by lack of exercise, certain 
forms of stimulation, and by dryness of the atmosphere. 

Watery vapor passes out from the body through the 
lungs with expired air to the amount of from 1 to 2 
pounds daily. 

Asphyxia is oxygen starvation. When the supply of 
oxygen to the lungs is cut off or diminished, the carbonic 


RESPIRATION AND TEMPERATURE 


89 


acid is retained in the blood. Normal breathing ceases 
and death occurs unless the condition is relieved. 

Foods when oxidized (burned) within the body cells, 
unite with oxygen, with the result that new energy is 
given to the cells. Oxygen is necessary for the burning 
of all substances. If a lighted candle be placed under an 
inverted glass it will soon go out because the oxygen in the 
vessel is exhausted. Likewise body cells will die if de¬ 
prived of oxygen. 

Temperature.—The chemical elements of the body 
are always undergoing a change. The foods supplied 
to the body undergo a form of combustion similar in 
many respects to the chemical changes which take place 
in coal, wood, or other fuel when brought into contact 
with heat-producing chemical substances. 

Oxidation has been defined as the process of combining 
with oxygen; of adding oxygen to or of subjecting to the 
action of oxygen. In all forms of oxidation heat is 
generated. The temperature of the body is maintained 
by the opposing chemical processes, heat production 
and heat elimination. By means of the blood the oxygen 
and the nutritive material to be oxidized are carried to 
all the cells and tissues of the body. Muscular exercise 
increases heat production. During sleep less fuel is 
consumed and less heat generated. 

Heat elimination is accomplished by means of the skin, 
the mucous membranes which are exposed to the air, 
and the. loss of warm body substances, such as the excre¬ 
tions. The temperature of the surrounding atmosphere 
is lower than the body temperature, and, by contact with 
the surface of the body, assists in preventing the accumula¬ 
tion of heat. The balance of body heat is controlled by 
the nervous system. When this balance is disturbed, 
the temperature changes, though there is a definite cycle 
of normal variation each day. In certain forms of fever 
the action of the poison causes more rapid burning up of 
tissues and, consequently, higher temperature. Heat 


90 


ANATOMY AND PHYSIOLOGY 


elimination or loss is accomplished to a large extent by 
means of the arteries, which are close to the surface of 
the skin. Cold has the effect of contracting them. When 
the body surface becomes thoroughly chilled, the blood¬ 
vessels nearest the skin contract, the escape of heat 
through the skin is lessened, and the heat remains in the 
system, causing an elevation from the normal temperature. 

There is, however, a normal variation of temperature 
during the twenty-four hours. At night, when the vital 
activity of the body is least, the temperature will be 
found lowest. This occurs usually between 2 and 6 a. m. 
The average normal temperature of the body is 98.6° F., 
but it varies not only with the time but with the locality 
in the body. The variation is usually but a fraction of 
a degree. 

Temperature is also influenced by age; that of a child 
being, as a rule, somewhat higher, and in advanced age 
lower than the normal average. In children the system 
is very easily thrown out of balance, the equilibrium of 
the vital machinery being more or less in an unstable 
condition. In aged persons circulation is less active 
and tissue changes somewhat slower than in earlier 
adult life. 

Exercise, temperament, mental condition, food, and 
atmospheric conditions may all exercise a modifying 
effect on the temperature in health, and are quite liable 
to in disease. 

The most common causes of rise of temperature are 
the toxins of bacteria. 

The term “ crisis” is used to denote a condition in which 
the temperature falls from a high point to normal within 
about twelve hours. 

The term “lysis” is used when the fever and other dis¬ 
ease symptoms subside gradually. 


THE BLOOD AND -CIRCULATORY SYSTEM 


91 


CHAPTER VI 

THE BLOOD AND CIRCULATORY SYSTEM 
THE BLOOD 

The blood is a nutritive fluid composed of a trans¬ 
parent colorless liquid, called plasma, in which float red 
and white corpuscles. 

The red corpuscles are much more numerous than the 
white. Their function is to absorb oxygen and carry it 
to the tissues. 

Hemoglobin is the coloring-matter of the corpuscles. 
The color depends on the combination of the hemoglobin 
with oxygen. When oxygen is present in sufficient 
quantities the blood assumes a bright red hue and is 



Fig. 52.—Cells of blood: a, Colored blood-corpuscles seen on the flat; 
b, on edge; c, in rouleau; d, blood-platelets (Leroy). 

known as arterial blood. When the oxygen is lessened 
in the circuit of the blood through the tissues, the color 
changes to a dark purple and is known as venous blood. 

The white corpuscles (also called leukocytes) number 
about 1 to every 500 of the red corpuscles. They are 
capable of changing both form and place, and readily 
pass through the walls of the blood-vessels. 

The white corpuscles, besides contributing to the 
formation of new tissue, are believed to act as protectors 
to the body in destroying harmful substances that are 
formed in, or gain admission to, the system. 


92 


ANATOMY AND PHYSIOLOGY 


When outside of the blood-vessels they may undergo 
changes, and are said to assist in the formation of the 
new tissues where inflammation is present. 

The 'plasma consists chiefly of water which holds in 
solution proteid substances, certain mineral salts, and 
the elements from which fibrin is formed. The plasma 
carries nutritive material to the tissues. The red cor¬ 
puscles carry oxygen. 

The Lymph .—“The blood-plasma soaks through the 
thin walls of the capillaries and passes out among the 
body cells. After the plasma is outside of the capillaries 
it is called lymph. The lymph surrounds all the cells in 
the body and fills the spaces between the cells. A fresh 
supply of lymph is constantly escaping from the blood 



h * cL 


Fig. 53.—Various forms of leukocytes: a, Small lymphocyte; b, large 
lymphocyte; c, polymorphonuclear neutrophile; d, eosinophile (Leroy). 


and the amount of lypmh in the body is several times as 
great as the amount of blood.” 

The Junction of the lymph is to receive food and oxygen 
from the blood and pass them on to the cells, and to re¬ 
ceive the waste from the cells and pass it on to the blood. 

The Lymphatic Vessels .—“The lymph flows into the 
lymph capillaries which form a network among the cells. 
The capillaries unite and form larger vessels which finally 
empty the lymph back into the blood.” (Ritchie.) 

Fibrin is essential to the coagulation or clotting of 
blood. The amount of fibrin differs widely in different 
individuals. In some persons it is so deficient that 
alarming hemorrhages result from very slight causes. 

The chief functions of the blood are: 


THE BLOOD AND CIRCULATORY SYSTEM 


93 


To convey the nutrition derived from foods to the 
tissues. 

To convey materials for secretions to the glands which 
prepare them. 

To carry oxygen to the tissues. 

To collect waste matter and carry it to the excretory 
organs for removal. 

To distribute heat through the system. 

To keep the tissues of the body moist. 

In an adult of average size the amount of blood is esti¬ 
mated at about 8 pounds. About one-twentieth of the 
body weight is the ordinary proportion. 

THE CIRCULATORY SYSTEM 

The circulatory system consists of the heart and a 
system of closed vessels—the arteries, veins, and cap¬ 
illaries. 

The heart is a hollow muscular organ, pyramidal in 
shape, situated in the thoracic cavity, between the lungs. 
Its weight is from 9 to 12 ounces. Its base is directed 
upward, backward, and slightly to the right. Its apex 
is downward, pointing to the left. 

Cavities .—It is divided into four cavities, termed the 
right and left auricles and the right and left ventricles. 

The heart is lined by a serous membrane, called the 
endocardium and surrounded by the pericardium. 

The heart is a pump, which by its continuous action 
distributes nutritive matter to all portions of the body, 
and carries waste substance to the excretory organs. 

The auricles are the upper chambers of the heart which 
receive the blood. 

The ventricles , or lower chambers, expel the blood. 
The left side always contains pure blood, the right, impure. 

Valves .—The tricuspid valve guards the opening between 
the right auricle and the right ventricle. 

The bicuspid valve guards the opening between the 
left auricle and ventricle. This valve is also called the 
mitral valve. 


94 


ANATOMY AND PHYSIOLOGY 


The semilunar valves connect the ventricles on the 
right with the pulmonary artery; on the left with the 
aorta, the main trunk of the arteries. These valves 



Fig. 54. —The heart (Stoney). 


permit the blood to flow only in one direction—away from 
the heart. 

The auricles receive the blood which is poured into 
them from the great veins. As they become filled they 
contract, forcing the blood downward into the ventricles. 

The ventricles also contract, forcing it into the arteries. 
Regurgitation is prevented by the connecting valves. 

The contractions are regular, each being followed 
by a slight period of rest, during which the chambers 
are being dilated with blood. The dilation is called the 
diastole and the contraction the systole. 

Heart Sounds.—The rhythmic action of the heart 
causes two distinct sounds, which follow each other 





THE BLOOD AND CIRCULATORY SYSTEM 95 

closely and differ in character. The first sound is a 
comparatively long dull sound, caused by the contraction 
of the ventricles and the closing of the tricuspid and 
mitral valves. 

The second sound is short and sharp, occurs during 
the diastole, and is caused by the closing of the semilunar 
valves. 

Certain changes which take place in the valves as the 
result of disease tend to produce abnormal sounds which 
are characterized as “ murmurs. ” Failure of a valve to 



Fig. 55.—The circulation of the blood through the heart: IVC, In¬ 
ferior vena cava: SVC, superior vena cava; RA, right auricle; TV, tri¬ 
cuspid valves; RV, right ventricle; P, pulmonary valves; PA, pulmonary 
artery; Pv, pulmonary veins; LA, left auricle; MV, mitral valves; LV, 
left ventricle; A, aortic valves; Aa, arch of aorta (Page). 


close perfectly, allowing a part of the blood to flow back¬ 
ward, is called regurgitation, a common form of heart dis¬ 
ease. 

The pulse is the sudden distention of an artery, due 
to the volume of blood forced into it at the time of the 


I 



96 


ANATOMY AND PHYSIOLOGY 


contraction of the ventricles. The vessels always contain 
a certain amount of blood, and in order to receive the 
incoming volume must expand. This expansion of the 
arteries occurs about seventy-two times in a minute in 
adult life. 

BLOOD-VESSELS 

The arteries, veins, and capillaries comprise the system 
of blood-vessels through which the blood circulates. 

Arteries.—The arteries have three coats, forming a 
strong elastic wall. Proceeding from the heart, the 
arteries divide into two branches, and these divide and 
subdivide into smaller vessels, till they finally give rise 
to the capillaries, the smallest blood-vessels. 

“As age advances the arteries lose their elasticity, and 
become more or less rigid from changes taking place in 
their coats. It is this change which has given rise to the 
expression, ‘a man is as old as his arteries’; for a man of 
forty may have arteries which are similar to those we would 
expect to find in a man twenty years older.” (Watson.) 
Arteriosclerosis or hardening of the arteries is the direct 
or indirect cause of a very large number of deaths. 

Capillaries.—The walls of the capillaries are exceedingly 
thin, so that fluids readily pass through them. They are 
arranged like a network, and the changes which take place 
in the blood in its course through the body take place 
chiefly in these vessels. 

In these tiny vessels the blood flows very slowly; the 
plasma soaks through their walls, furnishing new food to 
the tissue-cells and taking up much of the waste matter 
which these cells have excreted. 

Veins are in structure similar to arteries, but the walls 
are thinner. Most of the veins are provided with valves 
(Fig. 57) which allow the blood to flow freely toward 
the heart, but resist any tendency to the flow in the 
opposite direction. Veins carry the blood back to the 
heart. They are situated close to the surface of the 
body. Arteries are deeper seated. 


THE BLOOD AND CIRCULATORY SYSTEM 


97 


“The forces keeping the blood in circulation are: 

“Action of the heart. 

“Elasticity of the arteries. 

“Capillary force. 

“Contraction of the voluntary muscles upon the veins. 

“Respiratory movements. 

“The time required for a complete circulation of the 
blood throughout the vascular system has been estimated 
to be from twenty to thirty seconds, while for the entire 
mass of blood to pass through the heart, fifty-eight pul¬ 
sations would be required, occupying about forty-two 
seconds.” (Brubaker.) 



Fig. 56.—Testing the blood-pressure with the Stanton instrument 
(Morrow). 


Blood-pressure.—By this is meant “the tension in the 
walls of the blood-vessels derived from the blood-current.” 
(Dorland.) 

For testing the blood-pressure an instrument known as a 
sphygmomanometer is used. The average blood-pressure 
7 














ANATOMY AND PHYSIOLOGY 


in an adult in normal health is between 120 and 140. 
In children it is lower, and as age increases it becomes 
higher. In certain forms of disease, where the blood- 
pressure is high, it sometimes rises to between 200 and 300. 
The pressure is estimated in millimeters on a scale marked 
on the sphygmomanometer. In general practice only the 
arterial pressure is registered. The usual average systolic 
pressure for normal adults is taken as “100 plus the age 
in years.” It will thus be seen that the normal blood- 
pressure rises with advancing age. At twenty it is 120, 
at fifty it is 150, and at eighty is 180, roughly speaking. 
Moderate variations on either side of the average are com¬ 
mon and without special significance. Moderate exercise 
and even a recent meal may cause a slight increase. ‘ ‘In¬ 
creasing blood-pressure is almost the common fate of 
every man with advancing years, and associated with it 
is a weakening of the elastic wall of the blood-vessels. 
The blood, moreover, attains with age an increased ad¬ 
hesiveness to the vessel wall, slackening its flow and bank¬ 
ing up the increased * pressure. Wony, the stress and 
strain of life, overeating and drinking, poisons, too, both 
chemical and morbid, and the wear and tear from over¬ 
work, all tend to bring about this condition of high blood- 
pressure. The next act in the drama is nature’s timely 
warning that we are exceeding the speed limit. This 
may take the form of a slight departure from usual health 
and efficiency or be of more serious intent. The most 
serious thing that can happen, of course, is for a blood¬ 
vessel in the brain—a structure that lends but little sup¬ 
port—to give way.” This is known as apoplexy. Paral¬ 
ysis, partial or complete, follows, and sudden death from 
this cause is common. 

Low blood-pressure is often found in persons of low 
general vitality. It is present in surgical shock during 
chloroform anesthesia and in certain diseases. 

Important Blood-vessels.—The aorta is the largest 
artery and leads from the left ventricle. It receives the 
pure blood from the lungs. 


THE BLOOD AND CIRCULATORY SYSTEM 


99 


The right and left 'pulmonary arteries lead from the 
right ventricle. These convey blood from the right side 
of the heart to the lungs. 



Fig. 57.—Diagram of the valves of veins (Morrow). 


The pulmonary veins communicate with the left auricle. 
These collect the blood after it has circulated in the lungs 
and convey it into the left cavity. 

The inferior and superior vena cavce are two large 
veins communicating with the right auricle. They 
collect the impure blood from all parts of the body and 
convey it into the right cavity of the heart. 

The coronary arteries are the arteries which supply the 
heart with blood for its own nourishment. They com¬ 
mence just outside the semilunar valves. The coronary 
veins collect the blood. These two sets constitute what 
is known as the coronary system, or the circulation 
within the heart itself. 

The common carotid arteries are located one on each 
side of the neck close to the trachea, and carry the blood 
to the head and neck. 

The temporal artery supplies branches to the head and 
scalp. 

The subclavian arteries are the beginning of the long 








100 


ANATOMY AND PHYSIOLOGY 


trunks which form the chief arteries of the upper ex¬ 
tremities. 

The radial artery passes down on the inner side of the 
forearm to the hand. It approaches the surface above 
the wrist, where the pulsation may be felt. 

The femoral artery is another in which pulsation may 
be felt. It is a continuation of the external iliac and is 



Fig. 58.—The abdominal aorta: Ai, Common iliac; i, external iliac; )i, 
internal iliac; sm, middle sacral; phr, inferior phrenic; lb, lumbar; c, celiac; 
mes, superior mesenteric; mei, inferior mesenteric; sr, capsular; r, renal; 
spi, internal spermatic; hi, internal hemorrhoidal (after Henle). 


found in the upper thigh on the inner side. Close to it 
lies the femoral vein. Arteries in which pulsation may 
be felt are the carotid, temporal, radial, and femoral. 

Veins are spoken of as deep and superficial, the deep 
veins accompanying arteries, the superficial collecting 
blood from the skin and superficial structures. 

The jugalar veins, situated on each side of the neck, 
receive the blood as it returns from the head and face. 







THE BLOOD AND CIRCULATORY SYSTEM 


101 



Facial. 


Innom¬ 

inate 


Heart 


Aorta 


Common 

iliac 


External 

iliac 

Internal 

iliac 


Brachial 


Radial 

Ulnar 

Palmar 

arch 


Femoral 


Axillary 


Popliteal 


Anterior 

tibial 


Posterior 

tibial 


Temporal 

External 

carotid 

Common 

carotid 

Subclavian 

Aorta 


Dorsalis 

pedis 


Fig. 59.—The principal arteries and veins of the body (Morrow). 
























102 ANATOMY AND PHYSIOLOGY 

These unite with the other veins to form the superior 
vena cava, the large vein through which the blood from 
the upper portion of the body reaches the heart. 




Fig. 60.—Veins and arteries of the thoracic and abdominal cavities: 1, 
Root of right lung; 2, section of diaphragm; 3, suprarenal body; 4, kidney; 
5, psoas magnus muscle; 6, quadrat us lumborum muscle; Aa, descending 
aorta; aA, arch of aorta; Ab, innominate artery; cs, left carotid artery; 
Ss, left subclavian artery; c, celiac artery; mes, mei, superior and inferior 
mesenteric arteries; cs, ci, superior and inferior venae cavae; Abd, Abs, right 
and left innominate veins; S, subclavian vein; je, ji, external and internal 
jugular; az, azygos vein; ic, intercostal vein; h, hepatic veins; phr, phrenic 
vein and artery; sr, suprarenal vein; r, renal artery and vein; lb, lumbar 
vein; spi, internal spermatic artery and vein; sm, middle sacral artery and 
vein; ai, common iliac artery and vein; H, hypogastric artery and vein; I, 
iliac artery and vein (after Henle). 


The inferior vena cava carries the blood from the lower 
part of the body back to the heart. 

Course of the Blood .—When the blood has been collected 




THE BLOOD AND CIRCULATORY SYSTEM 103 

by the vena cavse from all parts of the body, it pours 
itself into the right auricle, then passes into the right 
ventricle, then through the pulmonary arteries into the 
lungs, where it gives Up carbonic acid gas and takes in 
° x ygen. After circulating through the capillaries of 
the lungs, it is taken up by the pulmonary veins, and 
carried to the left auricle and downward into the left 
ventricle. The contraction of this ventricle forces it 
into the aorta and its branches, where it circulates, by 
means of the capillaries, into all the tissues except the 
outer layer of skin, hair, and other bloodless parts of the 
body. The veins then take up and carry it back to the 
vena cavse, and through these it passes into the right 
auricle, from whence it started. 

The nerve-supply of the blood-vessels is received through 
the vasomotor nerves, which are connected with the 
sympathetic system and are distributed to the muscle- 
fibers of the vessels. 

Vasoconstrictors cause the blood-vessels to contract, 
thus reducing the size. 

Vasodilators cause the blood-vessels to dilate. 

The pallor of fright is due to the action of the vasocon¬ 
strictor nerves, while blushing is due to the vasodilators. 

Heat stimulates the vasodilators so that more blood 
goes to the skin. 

Cold stimulates the vasoconstrictors and the blood is 
kept from the surface of the body. 


104 


ANATOMY AND PHYSIOLOGY 


CHAPTER VII 


DIGESTION AND ABSORPTION 


Digestion is the process by which the food introduced 
into the body is liquefied, and its nutritive principles 
changed by digestive fluids into a condition in which it 
is capable of being absorbed into the blood. 

The mouth or buccal cavity contains the tonsils, tongue, 
salivary glands, and teeth. The palate forms the roof 


of the mouth. The hard 
palate serves as a partition 
between mouth and nose. 
The soft palate forms a cur¬ 
tain between the mouth and 
pharynx. The center of the 
lower portion of the soft 
palate extends in pointed 
form, and is called the 
uvula. 



The salivary glands are 
compound glands, and are 
distinguished by the terms 


Fig. 6i. Dissection of the side parotid, submaxillary , and 
Of the face, showing the salivary su Uinqual. The submaxil- 
glands: a, Sublingual gland; b, sub- y 

maxillary gland, with its duct open- lary and Sublingual glands 

ing on the floor of the mouth be- ovp lnoatpH bplow the lflw 
neath the tongue at d; c, parotid are seated DeiOW me JAW 

gland and its duct, which opens on and under the tongue. The 


the inside of tbe cheek (after parotid ; g under and ; n 


front of the ear. These 


glands secrete the saliva, which is an important ingre¬ 
dient in digestion. 

The process which food undergoes has been divided 
into the following stages: Prehension, mastication, insal- 
ivation, deglutition, gastric and intestinal digestion, and 
defecation. 

The Digestive Apparatus.—The organs or parts of the 
body which constitute the digestive machinery are the 


DIGESTION AND ABSORPTION 


105 


teeth, the alimentary canal and its appendages, the liver, 
and pancreas. 

After the foods have been finely divided by the teeth, 
their digestion is accomplished by means of substances 
known as enzymes or digestive ferments, of which there 
are a number of different kinds, each by its contact with 



the food effecting some chemical change in the intricate 
process of digestion. 

The function of the teeth is to masticate or reduce 
the food to a finely divided condition, so that each par¬ 
ticle of it may come in contact with the digestive fluids. 
The adult teeth number thirty-two. These consist of 
four incisors, two canines, four bicuspids, and six molars 
in each jaw. 


































106 


ANATOMY AND PHYSIOLOGY 


The ease with which gastric digestion is carried on de¬ 
pends largely upon the thoroughness in masticating. 

Insalivation is the mixing of the food with the saliva 
secreted by the salivary glands of the mouth. The 
active element or principle of the saliva is the ferment 
known as ptyalin. 

The part performed by the saliva in digestion is the 
moistening and softening of all the food and the partial 
digestion of starches by the changing of starch into sugar. 
Starch is an insoluble substance and cannot be used in 
the body unless reduced to a liquid state. The action of 
the ptyalin accomplishes this change. From 1 to 2 
pounds of saliva is secreted daily. 

Deglutition is the act of swallowing. 

Gastric Digestion.—When there is no food in the 
stomach to be digested, the mucous membrane which 
lines it is covered with mucus and is pale in color. The 
introduction of food or any substance has the effect of 
stimulating the whole organ to activity. The blood¬ 
vessels dilate and more blood is sent to that part, changing 
the mucous membrane to a bright red color. The 
multitudes of small tubular glands which are embedded 
in the mucous membrane begin to pour their secretion 
into the stomach, and this secretion of gastric juice 
continues while the food remains in the stomach. This 
organ, during digestion, exerts a muscular action which 
by slow, regular, wave-like contractions keeps the food 
in motion. By this means it becomes thoroughly mixed 
with the gastric juices, and as soon as any part of the 
food is digested, it is carried along through the pylorus 
into the small intestine. The nerve supply of the stomach 
is of a very complex nature, and its activity is greatly 
influenced by nervous excitement of any kind. 

The gastric fluid has for its principal action the diges¬ 
tion of proteid substance. Albuminoid or proteid matter 
cannot pass through an animal membrane until changed 
into a solution known as peptones. This process of 
peptonizing proteids is, then, the chief work of the gastric 


DIGESTION AND ABSORPTION 


107 


juice. As peptones, the nutritive element, proteid, 
passes directly into the absorptive vessels located in the 
walls of the stomach. 

The gastric fluid is acid in its reaction and rapidly 
coagulates milk, fine, soft curds being formed. Meat is 
disintegrated by the acid juices. The contents of the 
stomach are reduced to a semifluid mass which has a 
milky appearance and an acid odor. This milky fluid 
is called chyme. 

Starchy foods and fats are not digested by the stomach. 
The process of changing food into chyme is termed 
chymification. 

The following table, prepared by Roberts, shows the 
use of each of the digestive ferments or enzymes: 


Table of Digestive Ferments 


Name. / 

1. Ptyalin or salivary diastase 

found in saliva. 

2. Pepsin found in gastric 

juices. 

3. Curdling ferment contained 

in gastric juice. 

4. Trypsin found in pancreatic 

juice. 

5. Curdling ferment found in 

pancreatic juice. 

6. Pancreatic diastase found 

in pancreatic juice. 

7. Emulsive ferment found in 

pancreatic juice. 

8. Bile poured into the duod¬ 

enum. 

9. Invertin found in intestinal 

juice. 

10. Curdling ferment found in 
intestinal juice. 


Function. 

1. Changes starch into dextrin 

and glucose. 

2. In acid fluids changes albu¬ 

minoids into peptones. 

3. Coagulates casein. 

4. In alkaline solutions trans¬ 

forms proteids into pep¬ 
tones. 

5. Coagulates milk casein. 

6. Changes starch into dextrin 

and glucose. 

7. Emulsifies fats 

8. Assists in emulsifying fats. 

9. Converts cane-sugar into 

inverted sugar. 

10. Coagulates casein. 


Intestinal Digestion. —At the conclusion of gastric 
digestion, the stomach contents (then called chyme) 
are poured into the duodenum. 

In the walls of the small intestine glands similar to 


108 


ANATOMY AND PHYSIOLOGY 


the glands of the stomach are situated. These glands 
secrete the intestinal fluid, which aids in the digestion of 
food. 

The character of chyme varies according to the food 
taken, but in general it may be said to consist of water, 
saliva, inorganic salts, undigested proteids and starches, 
cane-sugar, peptones, liquefied fats, and the indigestible 
part of flesh foods, cereals, vegetables, etc. In the 
intestines the chyme becomes mingled with bile, pan¬ 
creatic fluid, and the juices poured out by the various 
intestinal glands. Each of these has some part in finishing 
the work of digestion. The functions of the bile have 
been mentioned in a previous chapter. In brief, it may 
be said to prevent decomposition, emulsify fats, and 
stimulate peristalsis. The pancreatic fluid completes 
the digestion of fats. The intestinal fluids complete the 
digestion of proteids and sugars. 

While in the small intestine the nutritive products 
are taken up into the blood and the undigested residue 
is carried by peristaltic action through the ileocecal valve 
into the large intestine. 

The villi are numerous small finger-like projections on 
the inner wall of the small intestine, which greatly in¬ 
crease its power of absorption. 

The ascending colon possesses some power of absorption, 
and the liquids remaining are gradually lessened, leaving 
a more or less solid mass to be expelled by the process of 
defecation 

Summary of the Process of Digestion.—The diges¬ 
tion of starches is commenced in the mouth by the saliva, 
continued in the stomach by the swallowed saliva, and 
completed in the intestines by the intestinal fluids. 

The digestion of proteids is commenced in the stomach 
by the gastric fluids and continued in the intestines by 
gastric fluid, which is carried with the food, the pancreatic 
and intestinal secretions. 

The digestion of fats begins in the stomach by the 
fat cells being set free by gastric juices. Digestion is 
completed by the bile and pancreatic fluid in the intestines. 


DIGESTION AND ABSORPTION 


109 



Absorption is defined as the process of taking up certain 
substances and conveying them to the blood. 

Assimilation is the process which goes on in the tissues 
whereby they appropriate the nutritive material that is 
carried to them. 



Fig. 63. —Diagram showing the course of the main trunks of the ab¬ 
sorbent system: The lymphatics of lower extremities (d) meet the lac¬ 
teal of the intestines (lac) at the receptaculum chyli (r.c.), where the 
thoracic duct begins. The superficial vessels are shown in the diagram 
on the right arm and leg (s), and the deeper ones on the left arm (d). 
The glands are here and there shown in groups. The small right duct 
opens into the veins on the right side. The thoracic duct opens into 
the union of the great veins of the left side of the neck (t) (Yeo). 

The small intestine is the part from which absorption 
chiefly takes place. Sugars and peptones are partially 
absorbed through the stomach walls, and the process of 
absorption is completed in the large intestine. 

The process of absorption is accomplished in two ways: 
by means of the blood capillaries and the lymph-vessels 
or lymphatic system so called, because the vessels usually 




110 


ANATOMY AND PHYSIOLOGY 



\\S\\^ V 


Clavicle 


Cut edge of 
skin 

Submaxil¬ 
lary sali¬ 
vary gland 


Inferior constrictor 
Omohyoid 

Sternothyroid 
Internal jugular vein 
Sternohyoid 

Sternomastoid 


Splenius 


Small occipital 
nerve 


Posterior belly of 
digastric 
Stylohyoid 
Great auricular nerve 


Levator anguli 
scapulae 

Spinal accessory 
nerve 

Trapezius 

Descending branches 
of cervical plexus 


Fig. 64.—Lymphatic glands of the head and neck (after Leaf). 



Fig. 65.—Central (superficial) lymphatic glands of the axilla (after Leaf). 


contain a watery fluid. The lymphatic system is some¬ 
times spoken of as the absorptive system because of the 
important work of absorption performed by it. 
















DIGESTION AND ABSORPTION 


111 


The lymphatic system consists of lymphatic capillaries, 
vessels, glands, and two large vessels known as lymphatic 
trunks. ^ The lymphatic capillaries and vessels are inti¬ 
mately interwoven with the blood-vessels. The lymph¬ 
atic vessels of the small intestine are known as lacteals. 
During digestion the lacteals contain a milky fluid called 
chyle. 

The thoracic duct is the great general trunk of the 
lymphatic system. It lies just in front of the vertebral 
column. Into this the chyle is emptied. Its lower end 
is much enlarged and forms a receptacle for the chyle. 
Its upper end leads into a large vein where its contents 
join the blood-current. 

In general it may be said that the chief office of the 
lymphatics is “to collect the fluid part of the blood which 
exudes through the walls of the blood-vessels, and sub¬ 
stances, which though having once formed part of a tissue, 
are not yet waste material, but are capable of reorganiza¬ 
tion, and may, therefore, be adapted for nutrition ” 
(Furneaux). 

Metabolism is the term applied to the changes which 
take place in the tissue cells. These changes include 
both the building up and breaking down of tissue. 

Anabolism is the term applied to the building up of 
tissue cells. In a general way it corresponds to nutrition. 

Catabolism is the term applied to the breaking down or 
waste of tissue. The whole process of metabolism is 
being studied more than ever before, particularly as it 
relates to the undernourishment of school children. 


112 


ANATOMY AND PHYSIOLOGY 

CHAPTER VIII 

THE URINARY SYSTEM 

The urinary system consists of the kidneys, ureters, 
bladder, and urethra. 

The kidneys are bean-shaped bodies situated on either 
side of the upper lumbar vertebrae. Each kidney is en¬ 
veloped in a fibrous capsule and embedded in a mass of 
fat behind the peritoneum. 

In structure the kidney is a mass of minute, winding 
tubes, known as uriniferous tubules, which are distributed 
irregularly. The cells which line this system of tubes 
separate the urea and other waste products from the 
blood. Several tubes unite finally in one collecting 
tube, which conveys the waste to the branches of the 
ureter 

The ureters are slender ducts leading from the kidneys 
to the bladder. The upper end of the ureter widens and 
opens into a cavity which is called the pelvis of the 

kidney. . 

The bladder is the reservoir for the urme. When 
empty it lies almost entirely in the pelvis. 

The urethra is a canal lined with mucous membrane 
by which the bladder is emptied of its contents. A cir¬ 
cular constricting muscle, known as the sphincter muscle, 
surrounds the neck of the bladder and prevents the in¬ 
voluntary passage of urine. At intervals this muscle re¬ 
laxes and the muscles of the bladder contract to effect 
the discharge of the bladder contents. 

In the female the urethra is about \\ inches long and 
curves slightly downward. The outer opening is termed 
the meatus urinarius. 

The kidneys are both secretory and excretory organs. 
They secrete the urine by separating from the blood 
certain waste products, and are often termed (with the 
skin) the filters of the body. The amount of urme 
secreted daily varies, and is influenced by numerous 


THE URINARY SYSTEM 


113 


causes. Some physiologists claim that as much moisture 
is lost from the body through the skin as through the 
kidneys, and the action of the skin greatly influences the 
quantity of urine secreted. 

In a healthy adult the amount of urine discharged from 
the body in twenty-four hours is estimated at about 
2J pints or from 40 to 50 fluidounces. 

Normal urine is a pale yellow or amber fluid, slightly 
acid. The degree of acidity varies. That voided in the 
morning is more strongly acid; that voided after eating 
or during digestion, especially if the food is largely 
vegetable in character, may be either neutral or alkaline. 

Composition of Urine.—The chief ingredient in urine 
is water, which holds the solid matter in solution. 

Urea is the next most abundant constituent. It is 
estimated that about 500 grains of urea are excreted 
daily. 

Uric acid and a large number of other chemical mineral 
ingredients form the solid part of urine. The water 
exists in the proportion of 960 to 40 parts of solid matter. 

Urea and uric acid are substances formed from the 
breaking down of albuminous compounds in the body. 
The quantity of these ingredients will necessarily vary 
in proportion to the amount of nitrogenous food eaten. 
A strictly vegetable diet is said to reduce the amount 
of these ingredients in the urine about one-half. Rapid 
waste of muscular tissue, which takes place in fevers and 
certain other diseases, will also greatly influence the 
quantity of these solids. 

The amount of uric acid eliminated each day is estimated 
at from 5 to 10 grains. If an excessive amount is elimi¬ 
nated, it is deposited as a brick-dust sediment in the urine 
shortly after voiding. 

The color may vary considerably in health. The 
transparency may be lessened by the presence of mucus 
and larger quantities of solid ingredients. It will also 
vary more or less according to the food taken. 'When 
8 


114 


ANATOMY AND PHYSIOLOGY 



The kidneys, bladder, and their vessels viewed from behind (Cam]> 
bell): R, Right kidney; U, ureter; A, aorta; Ar right renal artery; Ve, 
vena cava inferior; Vr, right renal vein; Vu, bladder; Va, commence¬ 
ment of urethra. 














THE URINARY SYSTEM 


115 


the quantity of urine voided is excessive, it will usually 
have less coloring-matter. In highly nervous or hysteric 
conditions, the urine is usually very pale and copious 
in quantity. The same condition is present during 
convalescence after acute disease. During fever the 
urine contains, as a rule, more solid matter. 

Other conditions which may cause variation from the 
normal standard are the presence of blood, pus, bile, or 
bacteria; the action of certain drugs, notably turpentine, 
which changes the odor; carbolic acid or iodoform, when 
absorbed in excessive quantities, which cause a dark, 
smoky appearance; rhubarb or senna, which change it to a 
bright yellow; salol and guaiacol in large doses, copaiba 
and santal oil, all produce characteristic changes. 

Specific Gravity.—By this is meant the weight of a 
substance as compared with an equal volume of another 
substance taken as a standard. The specific gravity of 
normal urine is between 1015 amd 1030, the average be¬ 
ing 1020; that of water, 1000. 

Reaction is the mutual or reciprocal action of chemical 
substances upon each other. Normal urine has an acid 
reaction owing to the presence of certain acid mineral 
ingredients, but the degree of acidity varies. 

Micturition is the act of voiding urine. The neck 
of the bladder is surrounded by a circular muscle (the 
sphincter), whicheontracts to prevent the constant passage 
of fluid from the bladder. When the bladder becomes 
full the walls contract, the sphincter relaxes, and allows 
the contents to be discharged through the urethra. 

Retention, or the inability to void urine, occurs from 
various causes. The bladder may be temporarily par¬ 
alyzed; the sphincter, owing to nervous disturbance, may 
refuse to relax; there may be an obstruction of the 
urethra; or there may be a dulling of the senses with no 
desire to expel urine. 

Incontinence is the inability to retain the urine the 
normal length of time. It frequently occurs in children 


116 


ANATOMY AND PHYSIOLOGY 


and occasionally in adults, especially the aged. It may 
be due to weakness of the sphincter. In many cases of 
incontinence the bladder fails to completely empty 
itself, and may become dangerously and painfully dis¬ 
tended, though the urine is discharged at frequent inter¬ 
vals. 

Suppression , or absence of the urinary excretion, occurs 
when for any reason the kidneys fail to act. It is always 
a serious condition, which rapidly proves fatal if relief 
is not secured. The body becomes poisoned by the 
accumulation of its own waste products. 

Oliguresis is scantiness of urine. It may occur from 
a variety of causes, of which the chief are taking a small 
quantity of fluid, excessive perspiration, diarrhea, which 
rapidly drains the fluids from the body through the 
bowels, high fevers, and inflammation of the kidneys. 

Abnormal Constituents of Urine. —Of these, the two 
most frequently found are albumin and sugar. 

Albumin in the urine indicates that “the kidney cells 
are not doing their work properly, since they are allowing 
part of the food to escape from the blood and be wasted 
in the urine. Albumin is not a waste substance, but an 
important food element, and, therefore, has no business 
in the urine.” (Cuff.) The presence of albumin in the 
urine may be very temporary and does not always indicate 
serious disease. It is, however, always worthy of atten¬ 
tion, and, whenever possible, the cause should be searched 
for and removed. 

Sugar in the urine is less frequently found, but is always 
a serious condition. 

Two tests for albumin which nurses should become 
familiar with are the heat test and the cold nitric acid test. 

For the heat test fill a test-tube about one-third full of 
urine and heat it to boiling-point. If a cloudy precipitate 
appears in the urine, it is due to either earthy phosphates 
or albumin. If to the latter, the cloudiness will increase 
when a few drops of nitric acid are dropped from a 
pipet. 


THE URINARY SYSTEM 


117 


# I 1 } using the cold nitric acid test, pour a small amount of 
nitric acid into a clean test-tube to the depth of | inch, 
slant the tube, and pour down very slowly a few drops 
of urine. A white ring will be seen where the urine meets 
the acid if albumin is present. 

Sugar in the urine may be detected in various ways. 
Fehling’s test and Trommer’s test are common methods. 
These tests are best understood when taught by practical 
demonstration. 

Casts in the urine “have much the same clinical mean¬ 
ing as albumin, although either may occur without the 
other. These bodies get their name from the fact that 
they are formed in the tubules as a mould. In certain 
abnormal conditions of the kidneys the renal tubules 
become at points filled with a substance which hardens, 
thus forming ‘ casts ; of the tube. The casts are then 
washed out and can be found with a microscope in the 
urine. ■’'—Emerson. 

Other abnormal constituents occasionally found in urine 
are red blood-corpuscles, pus-cells, epithelial cells, mu¬ 
cous, and bile pigment. 

General Elimination.—The waste matter of the body 
consists mainly of old tissue cells, which are constantly 
breaking down in the body, and of food incapable of being 
digested or assimilated. A large amount of the waste of 
the body is carried off by the urinary system. The lungs, 
the skin, and the bowels are also actively engaged in the 
work of elimination. 

In order to prevent clogging of any of the machinery 
of the body by retention of dangerous waste products, 
plenty of water must be supplied daily. The neglect to 
supply the body with sufficient water to carry on this 
natural cleansing is a common cause of disease. 

The amount of waste of body tissue varies in propor¬ 
tion to exercise, occupation, external surroundings, etc., 
and is much increased in some forms of illness, notably 
fevers, in which the tissues are rapidly consumed by the 


118 


ANATOMY AND PHYSIOLOGY 


excessive heat of the body. The amount of nervous 
energy expended in an occupation is also a powerful 
factor in the process of waste. 


CHAPTER IX 

THE SKIN 

The skin forms a protective covering for the body. 
Its chief functions are: 

To afford protection to the deeper tissues. 

To assist in the elimination of waste products. 

To assist in regulating the heat of the body. 

It is the chief seat of the sense of touch. 

It consists of two layers: the epidermis, cuticle, or 
scarf skin, and the dermis, or true skin. 

The epidermis is the outer layer and differs in thickness 
in the different parts of the body. It is composed on 
the surface of flattened cells or scales, which are hard, 
horny, and dry. These epithelial scales are constantly 
wearing away, layer after layer falling from the surface 
of the body, as they are pushed up from below by the 
incessant growth of new cells. These dead epithelial 
scales form one of the common constituents of dust. 
The pigment granules or coloring-matter, which give the 
skin its varying tints, are located in the lower layer of 
the outer skin. 

Healthy skin has always a more or less pinkish tinge, 
due to the presence of blood in the capillaries of the 
true skin. It is more or less firm, smooth, and clear. 
The amount of pigment in the cells of the pigment layer 
determines whether the skin is dark or fair. The epider¬ 
mis has no blood-vessels, contains few nerves, and is 
impermeable to moisture. When the skin is perfect, 
poisons of various kinds may be handled without injury, 



THE SKIN 


119 


but a wound as small as a pin prick may afford an en¬ 
trance for such poisons into the blood. 

The dermis, or true skin, is composed mainly of con¬ 
nective and elastic tissues and has many blood-vessels 
and nerves. Underneath this is the subcutaneous tissue, 
into the construction of which fat enters largely. 

“The use of subcutaneous tissue is to fill up all the irregu¬ 
larities of surface in the underlying parts, and to give the 
rounded form and plumpness to the surface of the body. 
The fatty tissue also, being a bad conductor of heat, 


serves to keep the body warm by preventing the outward 
passage of heat. 

The sensibility of the skin as the organ of touch is due 
to the distribution of nerve-fibers, which terminate in the 
papillae of the dermis.” (Furneaux.) 

The skin is an organ both of secretion and excretion. 

A secretion is a substance prepared for further use in 
the body. 

An excretion is a substance that is separated from the 
tissues because it is useless or dangerous to the body. 

Secretion and excretion are performed chiefly by 
glands, located in all parts of the body, and varying in 



Fig. 66. Transverse section of skin from scalp, showing hairs cut trans¬ 
versely: ep, Epidermis; h, hairs; sbgl, sebaceous glands (Fox). 






120 


ANATOMY AND PHYSIOLOGY 


shape and structure according to their particular func- 
tion. 

Mucous membrane lines the alimentary tract, the 
respiratory tract, and the genito-urinary tracts. It is 
continuous with the skin, redder in color, more sensitive, 
and is kept constantly moist by a sticky fluid, known as 
mucus, which is secreted by small glands in the mem¬ 
brane. 



Glands.—The skin has two sets of glands: the sebaceous 
and the sudoriferous. 

The sebaceous glands are located in the true skin and 
connect with the hair that appears on the surface of the 
skin. These secrete an oily substance (the sebum), by 
which the skin and hair are lubricated and softened. 

The sudoriferous or sudoriparous or sweat-glands excrete 
the sweat. Their function is to separate from the blood 




THE SKIN 


121 


the elements that go to form perspiration. These are 
called the pores of the skin, the ducts reaching down to 
the subcutaneous tissue and opening all over the surface 
of the skin. The sweat-glands are governed by the 
nervous system. A cold sweat may be caused by fear. 
Other influences that modify the action of these glands 
are mental emotions, rise of temperature in the body or 
atmosphere, exercise, and certain drugs. 

Perspiration is defined as a watery fluid containing 
a small amount of dissolved common salt with a certain 
amount of other salts. Urea is a constant ingredient. 
The amount of perspiration varies with the season, the 
quality and quantity of food and drink, exercise, etc. 



and excretory duct (Sappey). 

It is continuously being eliminated, but usually passes 
off so gradually by evaporation that the individual is 
insensible to it. When, because of increased heat, or 
exercise, or other causes, the muscles of the skin relax, 
the gland ducts open wider, and a free copious perspira¬ 
tion results, this is termed sensible perspiration. 

When the pores of the skin become clogged so that the 
perspiration cannot escape freely, the poisonous elements 
are reabsorbed into the blood, and extra labor is thrown 


122 


ANATOMY AND PHYSIOLOGY 


on other excretory organs, especially on the kidneys. As 
a result the kidneys may become diseased from overwork 
in dealing with the excess of waste products. 

The chief use of perspiration is said to be the equaliza¬ 
tion of the temperature of the body or the protection of 
it from too great heat. 

Perspiration is increased by: 

1. Increased temperature of the air, water, or other 
heated substances with which the skin comes in contact. 

2. Copious drinking of warm water or watery sub¬ 
stances, especially if the fluid is hot. 

3. By rise of blood pressure with increased heart 
action. 

4. Increased temperature of the blood. 

5. Muscular exercise. 

6. Friction. 

7. Diaphoretic drugs. 

3. Electricity, which acts as a stimulant to the nerves 
controlling the. secretion of sweat. 

9. Mental excitement. 

10. Certain diseases, such as malaria, rheumatism, etc. 

“When the surrounding air is much warmer than the 

body, the vessels of the skin dilate, free perspiration 
takes place, and by its evaporation the body becomes 
cooled. If the air is already full of moisture, evaporation 
of the perspiration becomes more difficult, and we suffer 
more from heat than if the air were dry.” 

Perspiration is decreased by: 

1. Cold. 

2. Copious discharges of fluid from the bowels or 
kidneys. 

3. Drugs, such as atropin. 

4. Certain diseases, such as chronic dyspepsia, cancer, 
diabetes, etc. 

Physiologic Effects of Temperature.—As the nurse 
is continually called on to make applications of water 
and administer treatment through the skin, the following 
brief statement of the general principles which determine 


THE SKIN 


123 


the effect of hot, cold, and neutral applications may be 
useful, until fuller instruction in hydrotherapeutic pro- 
cedures can be obtained. 

Hot Applications .—The primary effect of heat is stim¬ 
ulating. The blood-vessels are dilated. The secondary 
effect, or the reaction, is depressant and sedative. The 
effects produced by an application of heat are influenced 
by the condition of the patient, the intensity and length 
of the application, the form of application, and other 
causes. 

Cold Applications .—Cold contracts the blood-vessels 
when first applied. It acts primarily as an excitant, 
then as a sedative. The secondary effect or reaction 
is invigorating and tonic. The effects produced depend 
on the method of application, the temperature, the 
condition of the patient, susceptibility, etc. 

Neutral Applications .—A neutral bath (one at a tem¬ 
perature of from 92° to 95° F.) slightly stimulates the 
skin and kidneys, and acts as a general sedative. Mixed 
effects are produced by intermediate temperatures, and 
all effects are modified by the use of mechanical methods, 
such as friction, percussion, etc., or by exercise before 


or after the application. 

Temperatures .—Cold.'..33 ° to 60 ° F. 

Cool.60° to 70° F. 

Temperate.,.70° to 85° F. 

Tepid.80° to 92° F. 

Warm.92° to 98° F. 

Hot.98° to 112° F. 


Appendages of the Skin.—The hair, sebaceous and 
sudoriferous glands, and the nails are spoken of as ap¬ 
pendages of the skin. 

Hair is found in almost all portions of the surface of 
the body. The color is due to the pigment matter. 

It assists in protecting the head from heat and cold. 

It prevents the entrance of foreign matter into the 
lungs, nose, ears, etc. 

It assists in retaining the heat of the body. 








124 


ANATOMY AND PHYSIOLOGY 


Each hair consists of a root and a shaft. 

The root is embedded in a point of skin called the 
follicle. 

Nails are thick layers of the horny scales of the epider¬ 
mis, their roots projecting deeply into the folds of the 



Hair shaft 


Derma 


Sebaceous 


Medullary substance of hair 
Cortical substance of hair 

Inner root sheath 
Outer root sheath - 


Hair bulb- 
Hair papilla- 


Fig. 69.—Section through hair and follicle (Fox). 


skin. The matrix or bed of the nail is a modification of 
the true skin. 

Nails are for the protection of the parts and to give 
strength when using the digits. 










GLANDS 


125 


GLANDS 

Glands are organs which secrete substances needed in 
the body. They separate certain materials from the 
blood and manufacture new substances. The glands of 
the body differ in many ways. A simple gland may be a 
small depression on the surface of a membrane or a gland 
may extend in a complicated system, opening by small 
ducts into the main duct, which carries the secretion to 
the surface for which it is prepared. 

Secreting glands are divided into three classes: Simple, 
compound, and ductless. 

Three essentials are characteristic of all glands. Each 
has a liberal blood-supply from which the material for the 
secretion is drawn; epithelial cells are the active secreting 
agents; they are directly controlled by the nervous system. 

Secretion is the term applied to the substance produced 
by the gland which is provided for use in maintaining 
bodily functions. 

External secretions are those which are carried away 
from the glands through ducts. Examples of external 
secretions are saliva, gastric fluid, pancreatic juice, bile, 
and intestinal fluid. 

Internal secretions are discharged into the blood or 
lymph without being carried off by a duct. It has been 
shown that some of the glands carry on their function 
both by means of ducts and without ducts. The pancreas 
besides secreting the pancreatic fluid which is discharged 
into the intestinal tract, also forms an internal secretion 
which is absorbed directly into the blood. 

The ductless glands , also called endocrine glands, have 
within recent years been made the subject of extensive 
research which has greatly influenced medical treatment. 
A new science, known as organotherapy or hormone- 
therapy, has been opened up which has produced remark¬ 
able results in a number of chronic diseases which had 
hitherto been regarded as almost hopeless. 

The ductless glands include the spleen, pituitary, adre¬ 
nals, thyroid, thymus, and gonads or “sex glands.” “The 


126 


ANATOMY AND PHYSIOLOGY 


secretions from these glands and their extracts contain 
the hormones or chemical messengers of the organ, which 
excite some of the most marvellous reactions known in 
physiology.” 

Some abnormal condition of the adrenal or other endo¬ 
crine gland is believed to be the foundation of much of 
the nervous trouble which affects women. It is well 
known that the sympathetic nervous system has an in¬ 
timate reciprocal relation with the ductless glands. 

The adrenals , or suprarenal glands, located on the top of 
the kidneys, are now known to perform several important 
functions, among which is the influence they exert on the 
regulation of the blood-supply and in maintaining the 
normal tone. Too much or not enough activity in the 
adrenal glands may result in uncontrollable nervousness, 
breathlessness on slight exertion, slow digestion, and ob¬ 
stinate constipation, with profound physical or mental 
depression. Chronic poisoning from the intestines or dis¬ 
eased teeth or gums are frequent causes of adrenal dis¬ 
turbance. 

The thyroid secretion has a profound influence on the 
power of the body to resist disease because of its power to 
convert toxic substances into relatively harmless material. 
It exercises a most important influence on metabolism, on 
both physical and mental growth, and on the complex 
processes by which body waste is disposed of. 

Thyroid deficiency is now recognized as complicating a 
great many of the disorders of childhood besides the more 
serious diseases, such as goiter, cretinism, etc. 

The thyroid gland is located near the trachea. 

The spleen is believed to exercise “a peculiar influence 
in stimulating digestion and in maintaining the mineral 
elements of the body in their proper solution.” 

The pituitary gland, situated at the base of the brain, 
exercises a powerful effect in promoting contraction of 
muscular tissue. Pituitary extract is much used in 
promoting uterine contractions in childbirth. 

Other important glands are the parotid and the sub- 


GLANDS 


127 


maxillary, which secrete saliva; the axillary, situated in 
the axilla; the lacrimal, which secretes tears; the sudorif¬ 
erous glands, which secrete sweat; the mammary glands 
or the breasts; and the liver, which secretes bile. 

Secretions. —Saliva moistens food and begins digestion 
of starches. 

Bile assists in digestion. 

Sweat helps to regulate body temperature and eliminate 
waste products. 

Mucus acts as a diluent and lubricant. 

Tears moisten the eyeballs and eyelids. 

Gastric fluid begins the digestion of proteins. 

Pancreatic fluid aids in digestive process. 

Milk is nature’s provision for food for infants. 

Serum lubricates surfaces. 

Vaginal secretion moistens, protects, and lubricates. 

Urine eliminates waste matter; is first a secretion and 
later an excretion. 


128 


ANATOMY AND PHYSIOLOGY 


CHAPTER X 
THE NERVOUS SYSTEM 

The nervous system is often spoken of as the ruler of 
the body. “ Its first great work is to cause all the parts 
of the body to work harmoniously together. Its second 
is to act as the organ of the mind.” 

“ The brain and spinal cord are often compared to a 
telegrapher in an office, and the nerves in the body to 
telegraph-wires that run out in all directions from the 
office. Over the wires the telegrapher receives messages 
that tell him what is going on about him, and he sends out 
messages commanding that certain things be done.” 

For general purposes it is convenient to divide the 
nervous system into two main divisions: the oerebro- 
spinal system and the sympathetic or ganglionic system. 

The cerebrospinal system consists of the brain and 
its nerves, and the spinal cord and its nerves. 

The sympathetic or ganglionic system consists of 
double chains of ganglia or knots of nerve matter situated 
on either side of the vertebral column, extending from 
the skull to the pelvis. Numerous disconnected ganglia 
distribute nerve-fibers to the internal organs and the 
walls of blood-vessels, supplying them with nerve influence. 
In the abdomen just back of the stomach is situated a 
large group of these nerves, known as the solar plexus. 
Other important plexuses or groups are the cardiac and 
pulmonary in the thorax and the hypogastric in the pelvis. 

Nerve tissue is of two kinds: cellular and fibrous 
tissue. Cellular nerve substance is found in the brain, 
the spinal cord, and all the nerve centers, and is grayish 
in color. It consists of cells which branch out and are 
interlaced with fibers. Fibrous nerve substance is 
composed of gray and white fibers, the gray being found 
chiefly in the sympathetic or ganglionic system, and the 
white forming an important part of the structure of the 
brain and spinal cord. 

A nerve is a whitish cord which conveys impulses or 
messages to all parts of the body. 


THE NERVOUS SYSTEM 


129 


A neurone is a nerve cell. 

A nerve center has the power to generate, receive, and 
transmit an impulse. 

A nerve can only conduct the impulse generated in 
the center. The two have been likened to an electric 


Fig. 70. —Transverse section of a nerve: a, Epineurium; b, perineurium; 
c, endoneurium; d, section of a single fiber (Leroy). 



battery, and the wires by which the electric current is 
conveyed. The nerve center is the battery which pro¬ 
duces the current; the nerves, the wires that conduct it. 

Motor nerves are those whose office is to produce 
motion. 


a b 



Fig. 71. —Nerve-cell with dendrites ending in claw-like telodendria: 
a, Neuraxis; b, telodendrion (Bohm and Davidoff). 


Sensory nerves are those by means of which we feel 
pain, hunger, or experience any other sensation. 

Vasomotor nerves convey impulses to blood-vessels 
and cause them to dilate or contract. 

Mixed nerves contain both motor and sensory fibers, 
9 





130 


ANATOMY AND PHYSIOLOGY 


and convey impulses in both directions by using different 
fibers. 

The nerves of the special senses are called afferent or 
sensory nerves. 

Afferent or sensory nerves conduct impressions to a 
nerve center only. 

Efferent or motor nerves conduct impressions from a 
center only. 

The brain is the great center from which issues the 
nerve force which vitalizes and controls the whole human 
system. The nerves are the servants which execute its 
commands and convey to it information concerning the 
outer world. The brain consists chiefly of soft nerve 
substance. The average, weight of a man’s brain is 



about 49 ounces, that of a woman, about 44, but a heavy 
brain is by no means a sign of special intelligence, for it 
is a well-known fact that criminals and persons of very 
meager intelligence have had unusually heavy brains. 

The pia mater is a thin membrane which surrounds the 
brain. It is really a network of arteries and veins inter¬ 
laced by connective tissue. From these vessels it receives 


THE NERVOUS SYSTEM 


131 


its blood supply. Outside the pia mater lies the arach¬ 
noid membrane, and between that and the skull is a tough 
fibrous membrane termed the dura mater. These three 
membranes, when spoken of collectively, are called the 
meninges. They enclose the spinal cord and divide the 
brain into a smaller and a larger portion. 

The cerebrum, or greater brain, occupies the upper and 
frontal portion of the skull. It is the seat of intelligence, 
of sensation, and emotion, the organ of the will and 
voluntary motion. 



The cerebellum, or lesser brain, is found beneath the back 
part of the cerebrum. It is the seat of muscular sense, 
by which we learn the condition of the muscles, and 
coordinate muscular movements. 

The medulla oblongata acts as a connecting medium 
between the brain and spinal cord, and controls the 
involuntary motions of breathing and swallowing. With- 







132 


ANATOMY AND PHYSIOLOGY 


out it life cannot be maintained, as breathing instantly 
ceases when it is removed or destroyed. 

The pons varolii is a bridge of nerve substance con¬ 
necting the two divisions of the cerebellum and passing 
around the medulla. 

The cranial nerves issue forth from the under surface 
of the brain. Of these, there are twelve pairs. These 
nerves produce the sense of smell, of sight, hearing, and 
taste, move the eyeball, and control the muscles of the 
eyes and face. The cranial nerves are numbered from 



F IG . 74.—Lumbar section of spinal cord, showing main tracts of white 
substance and location of principal groups of nerve-cells in gray matter: a, 
Anterior median fissure; b, posterior median fissure; c, anterior horn of 
gray matter; d, posterior horn of gray matter; e, central canal;/, anterior 
white commissure; g, posterior white commissure; h, i, anterior and pos¬ 
terior gray commissures; j, anterior median column; K, lateral column; 
L, posterior column; m, column of Clarke; n, inner group of nerve-cells; 
o, anterior group; p, anterolateral group; q, posterolateral group; r, lateral 
horn (Leroy). 


before, backward. The tenth pair, the pneumogastric 
nerves, are important mixed nerves, which send fibers 
to the liver, stomach, heart, lungs, and larynx. The 
fifth pair, the trigeminal nerves, are large nerves which 
send fibers to the skin of the face, the muscles of the 
lower jaw, and tongue. 

The olfactory nerves are the nerves of smell, the optic 
nerves those of sight, and the auditory nerves supply the 

ear. 





THE NERVOUS SYSTEM 


133 


The spinal cord extends in the spinal canal from the 
medulla oblongata to the first lumbar vertebra. The three 
coats of the brain extend down 
and enclose it. Between the 
arachnoid membrane and pia 
mater there is a fluid known 
as the cerebrospinal fluid, which 
serves as a protection to the 
brain and spinal cord. The dis¬ 
charge of this fluid from the ear 
is a most important symptom 
where injury to the skull is 
feared. Between the dura mater 
and the vertebra is a protective 
covering of fatty tissue, which 
prevents injury to the spinal 
cord when the back is bent. 

The spinal cord is a means by 
which motor and sensory im¬ 
pressions are conveyed to and 
from the brain. It is also a 
center of reflex action. 

Spinal Nerves. — Thirty-one 
pairs of nerves are thrown out 
from the spinal cord. At the 
lower extremity of the cord they 
are crowded into a bunch, called 
the cauda equina. The sensory 
nerve-fibers cross as they enter 
the cord. The motor nerves 
cross as they enter the me¬ 
dulla. 

“The nerves of the cerebro¬ 
spinal system are the nerves of 
conscious life, and are distributed 
to all voluntary muscles and to 
all sensitive structures, such as 
the skin, mucous membranes, 
lining of joints, and periosteum” (Bundy). 



Fig. 75.—General view 
of the cerebrospinal nervous 
system (after Bourgery: 
Schwalbe). 







134 


ANATOMY AND PHYSIOLOGY 


A reflex action is first an irritation of the sensory nerves 
which is communicated to the medulla and reflected 
along motor fibers to the termination of these fibers in 
muscles. This results in muscular contraction, which 
may be voluntary or involuntary. “Hundreds of reflex 
actions are going on continually in our bodies without 
our knowledge, and among them we include the so-called 
vital functions of the important organs, the cessation of 
which would cause instant death. Thus the action of 
the respiratory muscles is the ultimate result of a reflex 
action” (Furneaux). 

The sight of tempting food will often cause the salivary 
glands to increase the quantity of saliva, and may also 
stimulate the gastric glands to greater activity through 
reflex action. 


SENSATIONS 

Sensations are the result of three causes or conditions. 
There must be some disturbing condition or irritation 
of one or more of the fibers of the sensory nerves. This 
irritation or pressure must be carried along the sensory 
fibers to the brain, the great nerve-center. In the brain 
this irritation is translated into a condition of conscious¬ 
ness. 

Common or General Sensations. —General sensation 
is not localized, but is produced by means of nerves 
distributed over a wide area. Among these common 
sensations are heat, cold, pain, hunger, and fatigue. 

Pain may be distinctly localized, but there is always 
a condition of general discomfort accompanying it, and 
the same is true of hunger. 

Muscular sense is one of the general sensations which 
makes us aware of the condition of the muscles, and enables 
us to regulate the contractions of the voluntary muscles. 

Objective sensations are irritations produced by outside 
objects. 

Subjective sensations are within the body and are 
caused by a disturbance of the cerebrum. 


THE NERVOUS SYSTEM 


135 


SLEEP 

Sleep is defined by Brubaker as “a periodic condition 
of the nervous system in which there is a partial or com¬ 
plete cessation of the activities of the higher nerve- 
centers. The cause of sleep is a diminution in the quantity 
of blood occasioned by a contraction of the smaller 
arteries under the influence of the vasomotor nerves. 
During the waking state the brain undergoes a physiologic 
waste as a result of the exercise of its functions; after 
a certain length of time its activities become enfeebled 
and a period of repose ensues, during which a regeneration 
of its substance takes place. 

“ When the brain becomes enfeebled there is a diminu¬ 
tion of activity and an accumulation of waste products. 
Under these circumstances it ceases to dominate the 
medulla oblongta and the spinal cord. These centers 
then act more vigorously and diminish the caliber of the 
cerebral blood-vessels through the action of the vasomotor 
nerves, producing a condition of physiologic anemia and 
sleep. During this state waste products are removed, 
force is stored up, nutrition is restored, and waking finally 
occurs.” 


136 


ANATOMY AND PHYSIOLOGY 


CHAPTER XI 

THE ORGANS OF SPECIAL SENSE 

The special sensations are sight, hearing, touch, smell, 
and taste. 

The eye is the organ of vision. It consists of the 
eyeball, a round body composed of several layers or 
coatings, which, with its nerves, blood-vessels, muscles, 
and other tissues, fill its bony chamber, the orbit or eye- 
socket. It is protected from injury by the bones forming 
the socket, the eyelids and lashes, and is kept moist and 
clean by the lacrimal fluid, a salty fluid secreted by the 
lacrimal glands. 

The eyeball is loosely held in place by a fibrous mem¬ 
brane attaching it to the walls of the cavity. It is 
moved by six muscles, which rotate it in various directions. 


Upper lid-border 



Iris with corneal 
reflex anterior 


Sclera- 


Lower lid-border 

Fig. 76.—The anterior surface of the eyeball (Pyle). 


When at rest these muscles, if normal and well balanced, 
hold the eye so that its pupil is directly in front. If the 
muscles are weak or of unequal strength the eye will be 
turned inward or outward, constituting the condition 
known as strabismus or “cross-eye.” 

These muscles are attached to the ball of the eye, and 
at the back to the eye-socket walls. They are known as 
internal and external rectus, superior and inferior rectus, 
and superior and inferior oblique. In certain diseases and 
in some forms of poisoning some of the muscles may be 
paralyzed or weakened, so that they lose their power of 
co-ordination. In such cases there is double vision. 


THE ORGANS OF SPECIAL SENSE 


137 


The eyeball is made up of three distinct coats or layers. 
The outer layer consists of the cornea and the sclerotic 



Fig. 77.—Right eye from before, the eyelids separated by hooks: Ps, 
Plica semilunaris; Pis, Pli, superior and inferior lacrimal puncta; Car, 
lacrimal caruncle; Lpni, internal tarsal ligament. 

coat or sclera, the “white of the eye.” The sclera gives 
form to the eye and protects the delicate structures 


Ocular 

muscle 


Sclera 

Choroid- 

Ciliary muscle. 

Iris 

Conjunc. cul-de-sac 
Ant. chamber and 
aqueous humor 
Crystalline lens^ 
Posterior chamber 
Angle of ant. chamber 
Suspensory ligament 
of the lens 



Retina 

Optic 

nerve 

with 

central 

retinal 

artery 

Ocular 

muscle 


Cornea Vitreous chamber 

Fig. 78.—Vertical section through the eyeball and eyelids (Pyle). 


within. The cornea is a transparent membrane covering 
the front of the eyeball for about one-sixth of its surface. 
The cornea has no blood-vessels. 













138 


ANATOMY AND PHYSIOLOGY 


The choroid and iris constitute the second or middle 
coat of the eyeball. The choroid is the dark brown 
membrane lying within and close against the sclera. 
It has a network of blood-vessels. The tissues through 
which the blood-vessels pass contain numerous pigment 
cells which provide coloring-matter. The choroid coat 
does not extend over the center of the front of the eyeball. 

The choroid coat is concerned largely with the nutrition 
of the eye. Another use is to darken the chamber of the 
eye. 

The ciliary processes are formed by a folding inward of 
the choroid. They are the fringe-like processes that 
encircle the margin of the. eye-lens. 

The iris is a circular membrane directly back of the 
cornea. It also contains blood-vessels and the pigment 
matter which gives the color to the eye. Its center is a 
circular opening called the pupil. The muscular fibers 
composing the iris are capable of dilating or contracting, 
thereby changing the size of the pupil and regulating 
the amount of light admitted. 

“The ciliary muscle surrounds the circumference of the 
iris. This muscle is the chief agent in ‘accommodation.’ ” 
(Leonard.) 

The retina is the inner coat of the eye. It is the screen 
on which the images fall, a most complex and delicate 
structure, which is essential to vision. From the retina 
the optic nerve passes out to the brain. The optic nerve 
conveys sensations of light, but not of pain. 

The optic nerve is not a single nerve. Many nerves 
have their terminals in the retina, and are gathered into 
a bundle forming what is known as the optic nerve. One 
portion of the retina may be injured, as happens some¬ 
times in case of a hemorrhage, and other portions may still 
receive the images. 

Aqueous humor is a watery fluid found in the anterior 
chamber of the eye. 

Vitreous humor is a transparent semisolid substance 
which helps to give form to the eyeball. It is covered 
on its outer surface by a thin membrane. 


THE ORGANS OF SPECIAL SENSE 


139 


The crystalline lens is a solid body surrounded by a 
capsule kept in place by a ligament situated close behind 
the iris. It is convex in shape and transparent. Its 
function is to focus the rays of light with the formation 
of an image on the retina. 

The refracting apparatus consists of the cornea, aqueous 
humor, crystalline lens, and vitreous humor. By means . 
of these the rays of light are so manipulated that an image 
is produced on the retina. 



Fig. 79.—The tongue: A, Papillae (fungiform); B, papillae (circumvallate); 

C, foramen cecum; D, lingua tonsillar tissue (Campbell). 

Accommodation is defined as the power which the eye 
possesses of adjusting itself to vision at different distances. 

The eyelid is a movable fold of skin in front of the eye¬ 
ball. Its inner surface is lined with a mucous membrane 
called the conjunctiva. 



140 


ANATOMY AND PHYSIOLOGY 


The conjunctiva is exceedingly sensitive, and if a foreign 
substance lodges upon the membrane, it causes tears to 
flow in the effort to dislodge the foreign body. 

The lacrimal glands are located in the outer corner of 
each upper eyelid. “These glands secrete the tears which 
are carried across the eye to the inner corner, where they 
enter the lacrimal duct. The workings of the lacrimal 
glands give us another illustration of the effect of the 
mind on the body, for sorrow, pain, and sometimes anger 
cause them to secrete so abundantly that the tears can¬ 
not all be carried away by the lacrimal ducts, but over¬ 
flow on the cheeks.” 

The sense of touch is a modification of common or 
general sensation located in the skin. The thickness of 
the outer skin and the number of nerve terminations in 
a given area influence the sensitiveness of the skin. All 
parts of the body where there are sensory nerves are to 
some degree organs of touch, but in the skin, tongue, 
and lips this sense of touch or tactile sensibility is most 
acute. 

The sense of taste is located chiefly in the tongue 
and the mucous membrane of the palate, the roof of the 
mouth. The impressions of taste are produced by the 
substance or food coming in contact with the nerve- 
endings of the mucous membrane. The flavor substance 
must be either in solution or capable of being dissolved 
in the saliva, so that it may be absorbed. The irritation 
of these sensory nerve-fibers by the substance is trans¬ 
mitted to the brain, producing the consciousness of taste. 

The Nose. —The two sides of the nose open externally 
through the anterior nostrils, and at the back into the 
nasopharynx. The nasal bones form the upper and hard 
portion of the ridge of the nose. The lower portion is 
of cartilage and flexible. 

The turbinated bones are adapted by shape and position 
to increase the surface of the air-chambers and to obstruct 
somewhat the air-current. On and around the superior 


THE ORGANS OF SPECIAL SENSE 


141 


turbinated bone is the membrane which is the seat of 
smell. The mucous membrane which lines the nose is 
kept constantly moist with mucus which catches dust 
and germs in the air that is inhaled. The air which 
comes in contact with the moist mucous membrane 
becomes slightly moistened before entering the lungs. 
The mucous membrane contains large blood-vessels 
which warm the air. The sensitive nerves detect un¬ 
pleasant or dangerous odors. The air in passing through 
the rather tortuous passage through the nose has been 
moistened, warmed, and to a considerable extent purified 
and rendered suitable to enter the lungs. The advantage 



Lobule 


Fig. 80.—External ear (Randall) 


Fossa of 

Anthelix 


Helix 


Fossa of anthelix 


of this is rarely appreciated till one sees patients whose 
nasal passages are obstructed, as in “mouth-breathers.” 

The sense of smell is dependent on the olfactory 
nerves which are located in the mucous membrane which 
lines the upper part of the nasal cavity. These nerves 
expand as they reach their termination in the mucous 
membrane into olfactory bulbs. 

These olfactory bulbs are the centers in which impres¬ 
sions of odors are perceived as sensations. The sense of 
smell is lost once these bulbs are destroyed. In animals 





142 


ANATOMY AND PHYSIOLOGY 


which have a very keen sense of smell these bulbs are 
increased and highly developed. 

Temporary loss of smell is often caused by the swollen 
condition of the mucous membrane due to a cold or other 
causes. 

The ear is the organ of hearing. It consists of three 
parts: the external ear, the middle ear, or tympanum, 
or drum, and the internal ear, or labyrinth. 

The external ear consists of the pinna or auricle and 
the external auditory canal. These are outside the 



Fig. 81. —The drum-membrane and ossicles from within, showing 
attachment of malleus handle to drum-head, the insertion of the tensor 
tendon below the chorda, the axis of rotation through the gracilis process 
and the posterior ligament of the incus, and the tooth of its articulation 
with the malleus head (Randall). 


skull. The auditory canal is about inches in length. 
In the lining of the canal are glands which secrete cerumen 
or ear-wax. This, with small hairs found there, tends to 
protect the ear from dust, insects, etc. 

The middle ear , or tympanum, or drum is a small cavity 



THE ORGANS OF SPECIAL SENSE 143 

hollowed out of the temporal bone. It is separated from 
the external auditory canal by a membrane called the 
tympanic membrane. In it is a chain of small bones 
which serve to transmit sounds, which are caused by 
vibration in the atmosphere, across the cavity to the 
inner ear. 

The Eustachian tube, sometimes called the auditory 
tube, connects the cavity of the middle ear with the 
pharynx. It is partly bony and partly cartilaginous, 



Fig. 82.—Semidiagrammatic section through the right ear: G, Ex¬ 
ternal auditory meatus; T, membrana tympani; P, tympanic cavity; 
o, fenestra ovalis; r, fenestra rotunda; B, semicircular canal; S, cochlea; 
Vt, scala vestibuli; Pi, scala tympani (Czermak). 


and is lined by mucous membrane which is continued 
into the mastoid cells. It is an air-chamber or tube the 
function of which is to equalize the air pressure on both 
sides of the drum. Unequal pressure of air in the middle 
ear results in impairment of hearing. 

An opening at the back of the middle ear communicates 
with the mastoid cavity of the skull, a point which is 
frequently the seat of serious inflammation. 



144 


ANATOMY AND PHYSIOLOGY 


The internal ear or labyrinth is exceedingly complex 
in structure. It consists of a bony and a membranous 
portion. The interior of the labyrinth contains a clear 
fluid (the perilymph), which is secreted by the periosteum 
lining the bony walls. 

The auditory nerve conveys sensations of sound from 
the ear to the brain. 


NOTES ON SURGICAL ANATOMY 


145 


CHAPTER XII 
NOTES ON SURGICAL ANATOMY 

Scattered through the preceding chapters are numer¬ 
ous clinical applications of anatomy. The additional 
notes which follow on applied anatomy, particularly as 
it relates to surgical conditions, should aid in a better 
understanding of some common conditions encountered 
m the practice of nursing. 

Scalp Wounds—Almost every variety of wound may be 
observed on the scalp, and in these wounds there is a 



A ThJ’.SrS eC + t fc n sh °™g layers of scalp and structures beneath: 
A, I he skin B, the superficial fascia; C, the occipitofrontalis; D, sub¬ 
aponeurotic layer; E, pericranium; F , bone; G, dura mater (Campbell). 


tendency to persistent hemorrhage, which is often alarm¬ 
ing out of proportion to the real danger, and often quite 
difficult to check. 

Covering the vault of the skull are five layers—the 
skin, which is much thicker than in other parts of the body; 
the subcutaneous fatty tissue; the occipitofrontalis muscle 
and its aponeurosis; the subaponeurotic connective tissue 
and the pericranium. 

The pericranium corresponds to the periosteum covering 
other bones, but differs somewhat in its functions. 











146 


ANATOMY AND PHYSIOLOGY 


The larger superficial blood-vessels of the scalp have their 
general course upward toward the crown of the head. It 
is, therefore, possible to arrange a bandage around the 
head in such a way as to arrest hemorrhage or even to cut 
off the blood-supply. 

Mastoid cells, or the mastoid portion of the temporal 
bone, are often the seat of severe inflammation, develop¬ 
ing frequently as a complication of middle-ear disease and 
in infectious diseases. In infants the mastoid process is 
not visible until the second year. “Most of the mastoid 
cells are air-spaces. The cells vary greatly in size and 



F IG 84.—Diagram (anteroposterior) illustrating by the shaded portion 
(A) the situation of adenoid vegetations in the nasopharynx (Kerry. 


extent in different individuals. The facial nerve passes 
close to this part and may readily be involved in mastoid 
disease. Mastoid inflammation may readily extend to the 
membranes of the brain and produce meningitis. It may 
extend farther and cause abscess in the neighboring part 
of the brain.” (Treves.) 

The Eustachian tube, extending from the nasopharynx 
to the tympanum or middle ear, may become closed, and 
impairment of hearing may result from thickening of the 






NOTES ON SURGICAL ANATOMY 


147 


mucous membrane of the tube. This frequently results 
from inflammation extending from the pharynx, from en¬ 
larged tonsils, and postnasal growths, in which the open¬ 
ing into the tube is mechanically obstructed. “The near 
relation of the pharyngeal end of the tube to the posterior 
nares serves to explain a case where suppuration in the 
mastoid cells followed the plugging of the nares for nose¬ 
bleed.” (Treves.) 



Fig. 85.— Vertical section of month —.. a *r ... . 



The Pharynx. “The mucous membrane of the pharynx 
is very vascular and readily inflamed. * * * * Much ade¬ 
noid tissue is distributed in the mucous membrane, a dis¬ 
tinct collection of adenoid tissue stretching across the 
hinder wall of the pharynx between the openings of the 
Eustachian tubes. This deposit of adenoid tissue may 
undergo hypertrophic change, and the condition known as 




148 


ANATOMY AND PHYSIOLOGY 


‘adenoid vegetations’ or ‘post-nasal growths’ be produced. 
These growths may cause deafness and may block the 
posterior nares.” (Treves.) Where adenoid growths are 
present, the child is starved for air and the mouth- 
breathing habit is developed. 

Hypertrophy of the tonsils is commonly associated with 
adenoids, and tonsils and adenoid growths are often re¬ 
moved at the same time. The tonsil is very vascular, and 
the operation is often attended with severe hemorrhage. 



p IG 80 .—Surface markings shown within the mouth: A, Hard 
palate; B, soft palate; C , uvula; D, pillars of fauces; E, tonsils (Camp¬ 
bell). 

Secondary hemorrhage, occurring several days after the 
operation, is not unusual. 

The Axilla or Armpit.—The skin in this region is pro¬ 
vided with many short hairs and with numerous sebaceous 
and sudoriferous glands, which, owing to friction or other 
causes, are often the starting-point for superficial abscesses. 
The connective tissue in this space is very loose, allowing 
free movement of the arm, but also permitting of large 
collections of pus or blood in this region. The great im- 









NOTES ON SURGICAL ANATOMY 149 

portance of this space is due to the large vessels and nerves 
and the lymphatic glands located therein. 

Lymphatic glands, or lymph-nodes, are small round or 
oval structures varying in size from a pin-head to a small 
bean, intersecting the lymphatic vessels at numerous 
points throughout the body. In the neck, axilla, groin, 


beneath the knee, elbow, and in the abdomen, these glands 
are most numerous. Under certain conditions of disease 
in an organ or tissue these glands become enlarged, the 
disease extending along the course of the lymphatics until 
one gland after another becomes affected. 

The mammary glands or breasts are made up of lobes, 
which are again subdivided into lobules, each of which has 
a tube or duct leading into a main canal which opens on 
the surface of the nipple. The tissue cells of the breast 


Fig. 87.—Lymphatics of breast and axilla (Campbell). 





150 


ANATOMY AND PHYSIOLOGY 


are capable of secreting milk from materials found in the 
blood. “Each lobe of the breast may be likened to a 
bunch of grapes and the stem to the milk-ducts. Each 
breast has fifteen to twenty lobes, and the ducts leading 
from these lobes are all brought together in the nipple. 
Between the lobes or bunches, the irregular spaces are 
filled with fat and connective tissue. The gland rests 
on a bed of connective tissue, which separates it from the 



Fig. 88. —Sagittal section of breast: A, Gland substance; B, fatty tissue; 
C, lactiferous ducts (Campbell). 

chest muscles, ribs, and intercostal spaces.” (De Lee.) 
Mammary abscess is usually due to infection entering 
through a fissure or break in the skin of the nipple. The 
pus forms between the lobules of the gland. “Abscesses 
of the breast should be opened by incisions radiating from 
the nipple so as to avoid unnecessary damage to the 
mammary ducts. 

“As the chief blood-supply of the breast comes from the 


NOTES ON SURGICAL ANATOMY 


151 


axilla, and as the main lymph-vessels proceed to that 
region, it follows that malignant growths of the gland tend 
to spread toward the axilla rather than toward the middle 
line. (Treves.) 

Topographic Areas.— For convenience of description the 
runk of the body is divided into areas or regions, such as 
the anterior thoracic region. The abdominal region and 



Fig. 89. —Topographic areas of the anterior thorax (Kerr). 

the back is also divided into regions or areas to which 
definite terms are applied (Figs. 89, 90). The abdominal 
region is more frequently explored in surgery than the 
other regions. 

The abdomen or abdominal region is divided by an 
imaginary line horizontal into three main portions— 
upper, middle, and lower, or the epigastric, umbilical, and 
hypogastric regions. Vertical lines, drawn as in diagram 











152 


ANATOMY AND PHYSIOLOGY 


shown in Fig. 89, give six additional sections to whicn 
special names have been given (Fig. 90). 

The abdominal wall is composed of several layers skin, 
superficial fascia, which in the lower part can be readily 
divided into two layers, adipose tissue, muscle. The 
relative thickness of the abdomen depends more largely 
on the subcutaneous fatty or adipose tissue than on the 



Fig. 90.—Showing the topographic areas of the back (Kerr). 

thickness of the muscles. The muscular boundary serves 
as a protection to the viscera within. The abdominal 
muscles are capable of contracting to great rigidity. 

The linea alba, a tendinous white line down the front of 
the abdomen, is the line most frequently chosen for in¬ 
cisions into the abdomen. “At this point the abdominal 
wall is thin and free from visible blood-vessels.” 












NOTES ON SURGICAL ANATOMY 


153 


Ventral Hernia. —If the abdominal wall is to be as firm 
and elastic after operation as before, the several layers of 
tissue must be healed together securely as in the original 
arrangement. Occasionally this does not occur, and as 
the patient begins to stand and walk, pressure is brought 
to bear on the scar; the tissues gradually separate, leaving 
only one or two layers holding together. These are not 
sufficient to hold back the intestine and omentum, and a 
protrusion occurs formed by the layer covering the intes¬ 
tine and the omentum within. This is called ventral hernia. 



Fig. 91. —The abdominal regions: The heavy line at the upper border 
shows the extreme limit of the diaphragm. Imaginary lines divide the 
abdomen into different regions which, for the sake of clearness and pre¬ 
cision, are known as the right and left hypochondriac, the epigastric, 
the right and left lumbar, the umbilical, the right and left inguinal or 
iliac, the hypogastric (Kerr). 

It is detected by observing a protrusion, with a gradual 
thinning or widening at some point in the abdominal scar. 

The umbilicus or umbilical ring, the aperture in the 
abdominal wall by which the umbilical cord communi¬ 
cates with the fetus, is another surgical landmark of great 
importance. “Its location varies somewhat with the 
obesity of the individual and the laxity of the abdomen. 
* * * In the adult it is somewhat above the center of the 
body as measured from head to foot, while at birth it is 










154 


ANATOMY AND PHYSIOLOGY 


below that point. The fibrinous ring of the umbilicus is 
derived from the linea alba. To this ring the adjacent 
structures, skin, fascia, and peritoneum, are all closely ad¬ 
herent.” (Treves.) 

The abdominal cavity is enclosed by a wall formed by 
the abdominal muscles, vertebral column, and the ilium. 
The diaphragm is its roof. 

The peritoneum, which lines the abdominal cavity, is 
a serous membrane which folds in and around all the 
organs of the pelvis. In the male the peritoneum is a 
closed sac. In the female the Fallopian tubes form open¬ 
ings into the peritoneal cavity on either side of the uterus. 
(See p. 79.) In the female, peritonitis, or inflammation 



Fig. 92.—Transverse section showing arrangement of abdominal 
muscles: A, Rectus; B, external oblique; C, internal oblique; D, trans- 
versalis (Campbell). 

of the peritoneum, may result from infection introduced 
through the vagina and advancing into the peritoneal cavity. 

An omentum is a fold of peritoneum connected with the 
stomach. 

“The mesentery is the fold of peritoneum which attaches 
the intestine to the posterior abdominal wall. It consists 
of the mesentery proper, a membrane connecting the small 
intestine with the spinal column, and the mesentery of the 
cecum, colon, and rectum, called respectively mesocecum, 
mesocolon, and mesorectum.” (Dorland.) 

Ischiorectal fossa is the name given to the space be¬ 
tween the ischium and rectum. It is filled with loose con- 


NOTES ON SURGICAL ANATOMY 


155 


nective and adipose tissue, and is frequently the seat of 
infection resulting in abscess. 

Poupart’s ligament, also called the inguinal ligament, 
stretching from the spine of the ilium to the spine of the 
pubis, is an important landmark in surgery. 

“The lowest portion of the peritoneal cavity is in the 
pelvis, extending down about 3J inches in front of the 
rectum. In the female this is called the recto-uterine 
fossa, or pouch or culdesac of Douglas. In the male it 
is the rectovesical fossa.” 

The inguinal region is frequently the seat of disease or 
disturbance requiring surgical interference. The term 
“inguinal” means pertaining to the groin. 

The abdominal inguinal ring opens into the abdomen in 
the inguinal region, through the transversalis fascia. The 
subcutaneous inguinal ring opens through the external 
oblique muscle just above the pubic bone, being under the 
skin in the inguinal region. The inguinal canal is the 
passage connecting these two rings. The inguinal canal 
is smaller and narrower in the female than the male. The 
inguinal canal serves for passage of the spermatic cord with 
its vessels in the male, and the round ligament in the female. 

Inguinal hernia consists of the passage of part of the 
intestine or omentum through the inguinal canal. “The 
herniated bowel is contained within a sac which is always 
formed of the peritoneum.” (Treves.) 

The femoral ring forms a weak place in the pelvic wall, 
under the inguinal ligament, where the femoral vessels do 
not occupy the whole of the space in their sheath. The 
femoral or crural canal extends downward from this ring, 
and is larger in women than in men. Femoral hernia is 
much more common, in the female, and the tendency ap¬ 
pears to be increased by the weakening effects of preg¬ 
nancy on the abdominal walls. 

The Bladder. —Many of the surgical procedures relating 
to nursing require that treatment be administered either 
through the bladder, the vagina, or the rectum. The 
bladder is situated in the cavity of the pelvis, behind the 
pubes, in the adult. In infancy it lies in the abdomen. 


156 


ANATOMY AND PHYSIOLOGY 


Behind it, in the male, is the rectum. In the female the 
bladder is in front of the uterus, resting partly on the 
cervix, and is held in place by powerful ligaments. It may 
become so distended that the summit will be at the um¬ 
bilicus or above it. It has four coats. A peritoneal coat 
covers the upper surface and is carried back over the 
posterior portion; a muscular coat, a submucous coat and 
the mucous membrane which forms the interior lining. 
The mucous membrane of the bladder is very lax to allow 
of its accomodating itself to the varying changes in the size 
of the receptacle. Its average capacity in the adult is 
about one pint, but it is capable of great distention. 

The neck or cervix of the bladder is the commencement 
of the urethra. In the male the prostate gland surrounds 
the neck of the bladder. Enlargement of this gland is a 
frequent cause of retention of urine, or inability to entirely 
empty the bladder. This condition occurs very frequently 
in the male after sixty years of age. Prostatic abscesses 
are not unusual. 

In the female, owing to the comparative thinness of the 
walls that separate the vagina from the bladder and rec¬ 
tum, it happens occasionally that fistulous openings occur 
between the vagina and bladder and also between the 
vagina and rectum, thus allowing the urine sometimes to 
escape through the vagina, and sometimes the contents 
of the bowel to escape in the same manner. 

The rectum is capable of great distention. In fecal 
accumulations it is possible for the distended rectum to 
push the adjacent organs out of their natural position. It 
is also possible by the relaxing of certain ligaments, or the 
giving way of some parts of the walls of the vagina, for 
the bladder or the rectum to protrude into the vagina, 
thus producing what is known as a cystocele, a protrusion 
of the front wall of the vagina with a lowering of the base 
of the bladder; or a rectocele, a protrusion of the back wall 
of the vagina and the front wall of the rectum. This con¬ 
dition is usually due to injury to the perineum, that takes 
away the posterior support of the vaginal wall. 


NOTES 








. 















































































































■ 




























































































NOTES 


NOTES 


NOTES 


SECTION II 


elementary chemistrx^ 


CHAPTER XIII 
INTRODUCTION 

Chemistry is one of the important divisions of natural 
science. Two great departments of natural science are 
recognized: one, called natural history, includes geology 
and biology, which includes zoology and botany; the other, 
termed natural philosophy or physical science, includes 
mechanics, physics, and chemistry. 

Chemistry treats of matter in its smallest subdivisions. 
It deals with all kinds of substances. It examines the 
atoms of matter and changes of properties which even 
vast quantities of matter undergo by reason of changes 
in kind, in number, and in relative position of the atoms, 
which, in obedience to chemical affinity, are gathered to¬ 
gether in minute groups. In brief, chemistry is the 
science which treats of the composition of matter, prop¬ 
erties of substances, and energy within the substance. 
All the various sciences overlap to some extent. 

The Field of Chemistry. —In the study of chemistry we 
learn that every substance that we can see, feel, taste or 
smell, or in any way deal with by means of our senses, 
belongs in one or the other of two great classes—organic 
and inorganic substances. The former includes products 
having a definite structure produced by the forces of plant 
and animal life—milk, meat, wood, etc.—the latter dealing 
with minerals and the soil in which they are found. 

In every-day life there are countless applications of the 

157 



158 


ELEMENTARY CHEMISTRY 


principles of chemistry. It has to do with the various 
processes of cooking and heating; with the purity of food 
and water; with the changes which are constantly going 
on in the animal body and in the plant world which is 
all about us. 

Included in chemistry are a great variety of problems 
which have to do with agriculture and various manufac¬ 
turing processes. The manufacture of medicines, paints, 
dye-stuffs, soaps, etc., suggests one group of chemical 
problems; the preparation and uses of the various steel 
and mineral products another group; and the study of how 
fertility of soil may be increased or conserved leads off 
into still another great field, involving complex chemical 
processes. 

Elementary substances are the simplest of all substances. 
They cannot by any known means be divided or changed 
into other substances. A compound results when dif¬ 
ferent elements unite. For example, metallic iron is a 
chemical element or an elementary substance. Oxygen 
gas, always present in the air about us, is another. Iron 
when exposed to damp air soon becomes changed into a 
mass of iron rust. This rust is a compound made up of 
iron and oxygen united together. 

There are about eighty elements, of which about twenty 
are necessary to maintain physical life. Twenty-five are 
commonly found in every-day life, but many of the ele¬ 
ments are uncommon, occur in exceedingly small quanti¬ 
ties, and only in special localities. Words ending in ium , 
as aluminium, calcium, etc., suggest that the substances 
so named belong to the metallic group. 

The Construction of Substances— For purposes of anal¬ 
ysis all substances may be studied in mass, molecule, or 
by atoms. The mass is represented in substances as they 
appear in ordinary life. It represents the largest individ¬ 
ual portion of a substance. 

An atom is the smallest known portion of matter which 
retains its chemical properties. It cannot be further 


INTRODUCTION 159 

divided. Every substance which we see or know has been 
built up from atoms. 

The molecule consists of two or more atoms. The word 
means a little portion. It is the smallest part of a com¬ 
pound that can exist and maintain its chemical features. 
For example, a molecule of sugar contains three kinds of 
substance—carbon, hydrogen, and oxygen—each existing 
in the molecule in separate minute portions. The atoms 
of carbon, hydrogen, and oxygen differ distinctly from 
each other. 

Chemical Affinity .—Each atom and each molecule is 
possessed of an invisible power of attracting to itself 
other atoms. It manifests strong likes and dislikes. So 
strong is this power that it is difficult to keep certain sub¬ 
stances apart. This power is termed chemical affinity. 
For example, atoms of iron readily unite with those of 
oxygen, but absolutely refuse to unite with certain other 
substances. Each atom seems to possess its own special 
individuality and is always consistent in its likes and dis¬ 
likes. One of the principal uses of chemistry is to study 
the relations of the elements and of compound substances 
toward each other. It represents a vast field for experi¬ 
ment, for the discovery of new facts, and for applying 
these discoveries in every-day life. The recent great war 
has markedly stimulated chemical research, and has re¬ 
sulted in chemical discoveries which have a far-reaching 
influence in the welfare of mankind and of world commerce 
and progress. 

Atomic Symbols .—Each chemical element has an atomic 
symbol which is in most cases an abridgment of its 
name. 

Atomic Weight .—A great variety of methods of weighing 
atoms have been used. While atoms are too small to be 
weighed separately, yet their relative weights have been 
determined and agreed upon by scientists. The atomic 
weight of oxygen is 16, and the weight of one atom of 
oxygen is taken as the unit of the system. 


160 


ELEMENTARY CHEMISTRY 


TABLE OF IMPORTANT ELEMENTARY SUBSTANCES 


Atomic 


Name of element. 

Symbol. 

weight. 

Valence. 

Aluminium. 

A1 

27 

Ill 

Antimony. 

Sb 

120 

III, V 

Arsenic. 

As 

75 

III, V 

Bismuth. 

Bi 

208 

III 

Boron. 

B 

11 

III 

Bromin. 

Br 

80 

I 

Calcium. 

Ca 

40 

II 

Carbon. 

C 

12 

IY 

Chlorin. 

Cl 

35.5 

I 

Copper. 

Cu 

63.6 

I, II 

Gold. 

AU 

197 

I, III 

Hydrogen. 

H 

1 

I 

Iodin. 

I 

127 

I 

Iron. 

Fe 

56 

II, III 

Lead. 

Pb 

207 

II, IV 

Magnesium. 

Mg 

24 

II 

Manganese. 

Mn 

55 

II, IV 

Mercury. 

Hg 

200 

I, II 

Nitrogen. 

N 

14 

III, V 

Oxygen. 

O 

16 

II 

Phosphorus. 

P 

31 

III, V 

Potassium. 

K 

39 

I 

Silicon. 

Si 

28 

IV 

Silver. 

Ag 

108 

I 

Sodium. 

Na 

23 

I 

Sulphur. 

S 

32 

II, IV 

Tin. 

Sn 

119 

II, IV 

Zinc. 

Zn 

65 

II 


In connection with this lesson the following laboratory- 
exercises are recommended: 

1. Wet a strip of bright iron and expose to the air for 
a day or longer. 

2. Sulphuric acid has the power of taking up water. 
Put a few drops upon a cube of sugar. It will turn brown, 
then black, and will be found to be carbon. 

3. Potassium chlorate is a white salt consisting of 
potassium, chlorin, and oxygen gas. Heat about 5 grams 
in a test-tube. It will first melt, then seem to boil. Apply 
a glowing splinter to the gas escaping during the boiling. 

4. Burn a small portion of sulphur. Note the odor of 
the gaseous product formed. What became of the 
sulphur? 






























A FEW FUNDAMENTAL LAWS AND PRINCIPLES 161 

CHAPTER XIV 

A FEW FUNDAMENTAL LAWS AND PRINCIPLES 

The teaching of chemistry can be properly carried out 
when the theoretic instruction given in class is illustrated 
by experiments made in the laboratory. In every hos¬ 
pital there are easily available the common supplies and 
appliances needed to illustrate first lessons in chemistry. 
A simple outfit sufficient for a great number of chemical 
experiments would include the following: 

A Bunsen burner; several test-tubes of different sizes; 
a test-tube rack; a glass rod; several pieces of glass and 
rubber tubing; a supply of corks; a pipet; a funnel; a 
horn spatula; a supply of filter paper; litmus paper—blue 
and pink; a chemical thermometer; a hydrometer, lactom¬ 
eter, and urinometer; a small asbestos mat; a supply of 
gum labels; a graduated cylinder; a mortar and pestle, 
and a set of scales used for weighing very small quantities. 

A beginning can be made with the following list of 
drugs, by means of which a great variety of chemical 
processes and principles may be illustrated: 

1 ounce of common washing soda. 

1 ounce of baking soda. 

2 ounces of sugar. 

2 ounces of powdered sulphur. 

h ounce of powdered alum. 

2 ounces of sulphuric acid. 

2 ounces of hydrochloric acid. 

1 ounce of tincture of iron. 

1 ounce of chlorid of lime. 

2 ounces of cornstarch. 

1 ounce of tincture of iodin. 

1 dram of solution of silver nitrate. 

2 ounces of iron filings. 

A few crystals of copper sulphate. 

2 ounces of potassium chlorate. 

2 ounces of nitric acid. 


162 


ELEMENTARY CHEMISTRY 


Chemists’ Symbols. —As previously stated, in chemistry 
a system of symbols has been worked out and accepted. 
The symbols constitute the shorthand alphabet or sign 
language of the student of chemistry. It would be prac¬ 
tically impossible for the average pupil in a hospital to 
remember the symbols which signify all the complicated 
compounds, the list of which is constantly increasing, 
but a study of the symbolic language used to designate 
the comparatively few which relate to common substances 
in daily use can be compassed by the earnest student who 
applies herself to the task, and is a great help in under¬ 
standing the science. For example, oxygen is symbolized 
by the letter O, hydrogen by H, Carbon by C, sulphur by S. 

A chemical symbol, therefore, represents the name of 
an element. It stands also for a definite weight of the 
element, which may be termed the symbol weight. 
O represents 16 parts by weight of oxygen. S represents 
32 parts by weight of sulphur. The symbol is usually 
the initial letter of the name. In case of two or more 
elements having the same initial, two letters may be used, 
or the initial letter of the Latin name. Iron is represented 
by Fe from ferrum. 

A formula represents the name of a compound. It con¬ 
sists of two or more symbols written together. The 
formula also stands for a definite weight called the formula 
weight. For example, C0 2 means 44 parts by weight 
of carbon dioxid. 

Valence .—The power of an atom to combine with or 
displace a certain number of other atoms is called its 
valence. In formulas this must be raised to a common 
multiple, which is indicated by adding a little sub-figure 
after the symbol of the atom. For example, the formula 
of water, in which hydrogen with valence I unites with 
oxygen, valence II, must be H 2 0. Sodium and chlorin 
each have a valence I, so the compound formed when they 
unite is NaCl. Again, carbon has a valence IV; its union 
with oxygen is represented by C0 2 . 

Reactions .—The term chemical reaction is used to in- 


A FEW FUNDAMENTAL LAWS AND PRINCIPLES 163 

dicate the changes and interchanges among the elements 
by which new compounds are produced. The method 
by which the reaction is expressed or stated is termed a 
chemical equation. 

A short way of writing out the kinds of atoms and 
how many of each are in a compound is also in general 
use. Each initial alone stands for a single atom. For 
example, “water is expressed by the symbols H 2 0 (H two 
0), meaning that in a molecule of water there are two 
atoms of hydrogen and one atom of oxygen. For carbon 
dioxid, the poisonous gas which we breathe out from the 
lungs, and which is formed when anything containing 
carbon is burned, chemists write C0 2 (CO two), meaning 
that in a molecule of this gas there are one atom of carbon 
and two of oxygen.” (Ritchie.) 

Physical and Chemical Changes.—Matter is anything 
which occupies space and possesses weight. Matter 
exists in three forms—solids, liquids, and gases. 

Biology is the science which treats of living matter, of 
the structure, life, growth, and actions of living organisms. 

The material world in which we live is constantly under¬ 
going change. Matter is constantly being broken up. 
Compound substances are reduced to simple elements, 
and these simple substances are being built into new com¬ 
binations. The term biologic change is applied to the 
changes which take place in our bodies, and which enable 
them to live and grow. Death results when these vital 
changes can no longer proceed in a normal healthy manner. 

These changes are of two kinds—physical and chemical. 
Physical changes are more or less transient. They are 
changes of form. By the action of outside forces solids 
may become liquids, liquids may become gases, and the 
reverse is also true. For example, water is liquid at 
ordinary temperatures. At certain other temperatures it 
becomes ice, and at other temperatures it vaporizes or 
changes to steam. If these temperatures change, it 
again readily assumes its original form. A physical 
change does not involve the formation of a new substance. 


164 


ELEMENTARY CHEMISTRY 


A chemical change involves the formation of a new sub¬ 
stance. 

In the economy of nature nothing is lost. Wood and 
coal burn in our* stoves. The invisible product of their 
combustion, CO 2 , passes into the air, but adds a definite 
amount to the weight of the air. Thus the symbol of this 
product shows that 12 pounds of coal (which when free 
of ash is nearly pure carbon) in burning takes from the 
air 32 pounds of oxygen and gives back to the air 44 
pounds of carbon dioxid. 

Oxidation is the term applied to one of the most im¬ 
portant chemical changes which takes place inside or out¬ 
side the animal body. It indicates the union of oxygen 
from the air with another substance. Under the steam- 
boiler and in the stove it is called combustion. It is the 
chief source of available power or energy in either case. 
The same amount of heat is evolved when a given amount 
of substance is oxidized, whether the combustion takes 
place slowly or rapidly. 

Experiments illustrating text of this lesson: 

1. Write the formulas for compounds of the following' 

Calcium and chlorin. 

Mercury and iodin (two). 

Zinc and sulphur. 

Hydrogen and chlorin. 

Aluminium and bromin. 

2. Heat an iron wire in a Bunsen flame. Is its composi¬ 
tion affected? 

3. Hold a piece of wood in a flame. (Compare with 2.) 

4. Tear a piece of paper into bits so small they are as 
lint on the fingers. Is this a chemical or physical change? 

5. Hold a piece of paper above a sink and apply a 
match. Gather some small bits and compare with 4. 

6. Into a test-tube pour 5 c.c. of water. In this place 
about one gram of baking soda. Now add 4 or 5 drops 
of hydrochloric acid. 

7. To show water is one of the products of combustion, 
hold a cold, dry beaker above a flame. 


SOME COMMON ELEMENTS AND COMPOUNDS 165 


CHAPTER XV 

SOME COMMON ELEMENTS AND COMPOUNDS 

The atmosphere, or the air which surrounds us and which 
is essential to life, is a mixture of invisible gases, chiefly 
oxygen and nitrogen. In addition to these two principal 
substances, a certain proportion of watery vapor is found 

with small amounts of other gases, of which carbon dioxid 
is one. 

The quantity of watery vapor in the air, termed hu¬ 
midity, is variable, and depends on numerous factors, 
especially the temperature of the air and the proximity 
of large bodies of water from which evaporation may take 
place. Humidity helps to retain the heat of the sun and 
contributes to the maintenance of animal and vegetable 

Oxygen exists in the air in about the proportion of 
one-fifth to the whole. It is present in much larger quan¬ 
tity in the earth. It readily combines with most of the 
other elements. It is essential to respiration and to 
animal life. In combination with hydrogen it forms water. 
It is one of the important constituents of animal and plant 
substances. 

Oxidation, or the union of oxygen with other elements, 
is always accompanied by heat. When oxidation takes 
place very quickly, and heat is evolved rapidly, a flame 
is produced. This process is termed combustion. The 
union of oxygen with matter frequently goes on so slowly 
that it is impossible to detect the process, though the 
results are invisible. The union of oxygen with iron 
produces iron rust—a form of iron oxid. 

Nitrogen is an inert gas which forms almost four-fifths 
of the air. It dilutes the oxygen, the most active constit¬ 
uent of the air. In the form of protein it is one of the 
essentials of food, and is present in every living cell. It 
is taken up from the soil by the roots of plants, is one of 
the important constituents of fertilizers, and has an im- 


166 


ELEMENTARY CHEMISTRY 


portant place in the commerce of the world. Its im¬ 
portant compounds—ammonia, saltpeter (potassium ni¬ 
trate), nitric acid, and nitrous oxid or laughing gas 
are largely used in the manufacture of medicines. 

Hydrogen constitutes about 11 per cent, of water. 
“Combined with carbon it forms kerosene, gasoline, 
lubricating oils, and the other components of petroleum. 
Natural gas and illuminating gas are mixtures of free 
hydrogen, hydrogen compounds, and carbon monoxid. 
Hydrogen is a constituent of all plant and animal life. 
It comprises about 10 per cent, of the human body. 
Hydrogen is an essential constituent of all acids.” (Irvin, 
Rivett, and Tatlock.) 

Carbon is a constituent of all organic substances both 
animal and vegetable. Its compounds are very numerous. 
It is one of the important ingredients of diamonds, coal, 
coke, graphite, charcoal, soot, and lampblack. 

Carbon dioxid, C0 2 , is present in the atmosphere to 
the extent of about 3 parts in 10,000. “It is given off 
by the processes of decay and combustion of organic 
substances, by the respiration of animals, and by the 
burning of fuel.” When carbon burns it combines with 
the oxygen of the air, forming an invisible compound gas 
called carbonic acid gas. 

Chlorin is a poisonous yellowish-green gas of char¬ 
acteristic odor, extremely irritating to the mucous mem¬ 
brane when inhaled. It is contained in common salt, 
and, therefore, has an important place in human food. 
It is used extensively in bleaching powders. It has a 
strong affinity for hydrogen and for the metals. Chlorid 
of lime consists of lime saturated with chlorin. Three 
compounds of chlorin that are of great importance in 
medicine are hydrochloric acid, sodium chlorid, and potas¬ 
sium chlorate. 

Bromin is one of the elementary substances. It 
derives its name from the Greek word bromos (a bad 
smell). It has decided resemblance to chlorin and mani¬ 
fests the same affinity. Many metals burn in it, forming 


SOME COMMON ELEMENTS AND COMPOUNDS 167 

bromids, which are important medicinal agents. It is a 
dark red liquid, and when spilled on the hands produces 
sores which heal with difficulty. 

lodin is found in combination in the ashes of sea-weed. 
Traces of it are found in the thyroid gland. It dis¬ 
solves freely in alcohol. In chemical characteristics and 
affinity it closely resembles chlorin and bromin. Several 
of its numerous compounds, the iodids, are valuable 
medicinal agents. It has important uses in photography. 

Sulphur, a yellowish inflammable substance, is found 
widely distributed in animal and vegetable matters. It 
has strong affinities and combines with the majority of 
other important elements. The presence of sulphur in 
an egg is shown by the blackening of the silver spoon with 
which the egg is eaten, the sulphur from the egg and the 
metal from the spoon combining in sulphid of silver. 
Among its important compounds are magnesium sulphate 
and sulphuric acid. 

Sodium and potassium are the two most important of 
the alkali metals. Sodium is found in nature chiefly in 
the form of sodium chlorid (common salt), deposits of 
which are found on every continent. Sodium chlorid 
is used extensively in making other sodium compounds, 
in the preparation and preserving of food, in the tanning 
industry, in the extracting of copper and silver from their 
ores, and as a glaze for earthenware. 

Potassium is a silvery white shining metal. It is found 
in rocks and in the soil. Wood-ashes contain potassium, 
chiefly in the form of carbonate. Potassium nitrate or 
saltpeter is found in the soil, where it has been formed by 
the decay of animal substances. Potassium chlorate is 
used in the manufacture of oxygen, matches, fireworks, 
and explosives. It is frequently used in the form of 
tablets for sore throat. Potassium has numerous and 
important compounds—potassium hydrate, potassium 
chlorate, potassium iodid, potassium bromid, etc. 

Calcium belongs to the group known as alkaline earth 
metals. In characteristics calcium, barium, and stron- 


168 


ELEMENTARY CHEMISTRY 


tium are similar. Calcium carbonate, CaC 03 , is one of 
the most abundant of the compounds found in the earth, 
chiefly in the form of limestone, used largely in the manu¬ 
facture of lime, soda, glass, and cement. Calcium oxid, 
CaO, or quicklime, when exposed to the air, absorbs 
carbon dioxid and water and is gradually converted into 
hydroxid and carbonate. Calcium hydroxid dissolves 
slightly in water, forming lime-water. 

Phosphorus plays an important part in the chemistry of 
animal and vegetable life. It is never found free or un¬ 
combined. It is found in nearly all soils, and is an es¬ 
sential constituent of bone and brain. Because it is known 
that plants do not flourish in soil that is barren of phos¬ 
phorus the manufacture of bones into fertilizer has be¬ 
come a great commercial industry. It is used in the prep¬ 
aration of the friction match. It is strongly poisonous 
and combustible. Laborers in phosphorus works are 
subject to a painful disease, known as phosphorus necro¬ 
sis, which has a destructive effect on the bones of the jaw. 
Phosphorus combines freely with oxygen. Sodium phos¬ 
phate and calcium phosphate are common examples of 
its use in drugs. 

Copper is used chiefly in medicine in the form of copper 
sulphate, a valuable cauterizing agent. It is one of the 
chief constituents of Bordeaux mixture used for spraying 
fruit trees. 

Silver is used extensively in commerce. Silver nitrate 
or lunar caustic, and another compound, argyrol, are used 
for cauterization purposes. 

Iron is one of the common metals of the earth. Some 
of its compounds are valuable drugs. It is found in the 
blood in the form of hemoglobin. 

Mercury is a dense silver-white liquid. Because of its 
high specific gravity it is used in making barometers, 
and on account of its uniform expansion is used as the 
liquid in thermometers. It has numerous compounds, of 
which calomel (mild chlorid of mercury) is one. Bichlorid 


SOME COMMON ELEMENTS AND COMPOUNDS 169 


of mercury is extensively used as a disinfectant, and has a 
strong corrosive effect on metals. 

Zinc is a metal used in medicine, chiefly in the form of 
zinc oxid (also used in making paint); zinc sulphate, pre¬ 
pared by the action of sulphuric acid on zinc, used as an 
antiseptic, and zinc chlorid, a caustic. 

Lead is used in medicine chiefly in the form of lead ace¬ 
tate or sugar of lead. Arsenate of lead is used in agricul¬ 
ture for destroying insect pests. All soluble lead com¬ 
pounds are poisonous. 

Boron.—This element is found chiefly in the desert 
regions of the world in the form of boric acid and borax. 
Boric acid is extensively used as an antiseptic. Borax 
is used chiefly for laundry purposes and as a glaze in pot¬ 
tery. 

Silicon constitutes more than one-fourth of the weight of 
the earth’s crust. Its compounds have many uses in 
industries, such as the making of glass, porcelain, mortar, 
etc. 

Bismuth is a crystalline metal with a reddish tinge. It 
does not combine with hydrogen. It is used in some of 
its compounds for toilet and medicinal purposes. 

Caoutchouc (pronounced koo'chook), commonly known 
as india-rubber or gum elastic, is a hydrocarbon. It is 
the concrete juice of various trees and plants. From it a 
rubber cloth is made that excludes water and moisture. 

Wax is a plastic substance deposited by insects or ob¬ 
tained from plants. The wax chiefly used in pharmacy is 
beeswax, from which honeycomb is made. 

Fats and Oils.—Fats are combinations of fatty acids and 
glycerin. The molecules of fatty acids contain varying 
amounts of carbon and hydrogen with a trace of oxygen. 
Fats and oils are found in both the animal and vegetable 
kingdoms. Among the oils secured from plants are olive 
oil, cottonseed oil, linseed oil, peanut butter, etc. Some 
varieties of nuts have large amounts of fats. 

Organic Compounds.—One of the peculiarities of or¬ 
ganic elements and compounds is that they are all easily 


170 


ELEMENTARY CHEMISTRY 


combustible. Most of them were believed to be derived 
directly from the plant or animal kingdom, and it was found 
that on the application of heat they would first char 
(showing the presence of carbon) and burn up completely. 

Through a long series of experiments it came to be rec¬ 
ognized that organic compounds are made of carbon, 
hydrogen, and oxygen, with occasionally the addition of 
nitrogen, sulphur, or phosphorus. The belief that these 
substances could only be produced by the living cell, 
which prevailed for a long time, had finally to be aban¬ 
doned, and today thousands of organic compounds are 
made artificially and new compounds are all the time being 
produced. The term carbon compounds indicates the 
most important group in the field of chemistry. “The 
organic molecule is built up around the carbon atom or, 
rather, around groups and chains of carbon atoms. Organic 
chemistry is sometimes described as the chemistry of the 
compounds of carbon.” (Ottenberg.) 

Synthesis is defined as the building up of a compound 
from its constituent elements, while the taking apart or 
the decomposition of the elements is termed analysis. 

Synthetic chemistry—the making of new and ever new 
organic compounds—has progressed so rapidly in recent 
years that it now plays a tremendously important part 
in the industries of the world. Man has learned to do in 
various ways what nature has been doing in her own way 
from the beginning of the world. We use the products of 
synthetic chemistry every hour of our fives in some form— 
dye-stuffs, flavoring extracts, perfumes, medicines, foods, 
fabrics. 

EXPERIMENTS 

1. Prove the presence of carbon dioxid in the breath 
by blowing through a tube into 5 c.c. of lime-water. 

2. Expose 5 c.c. of clear lime-water to the air for several 
hours. Result? When any insoluble compound is formed 
it is called a precipitate. Relate experiments (1) and (2). 

3. To a test-tube half full of water add a little starch 
paste, then a few drops of tincture of iodin. This action 


SOLUTIONS, ACIDS, BASES, AND SALTS 171 

of free iodin and starch forms a distinctive test for both 
substances. 

4. In a test-tube put three or four pieces of zinc, pour 
upon it about 8 c.c. of dilute sulphuric acid. Partially 
close the mouth of the test-tube and after a moment apply 
a flame. Let stand till action is completed. Then filter 
out any remaining portions of zinc, evaporate off the 
water, and notice the appearance of the product. It is 
zinc sulphate, and the escaping gas was hydrogen. 

5. Put a few drops of a solution of silver nitrate upon 
a piece of filter-paper. Expose to the light and note its 
effect on silver compounds. 


CHAPTER XVI 

SOLUTIONS, ACIDS, BASES, AND SALTS 

The term solution is used to designate a liquid with 
some other substance dissolved in it. Alcohol, ether, 
gasoline, chloroform, water, etc., have the power to 
hold other substances in solution. The substance, such 
as sugar, salt, etc., which is dissolved is called the solute 
and the liquid is termed the solvent. When water is mixed 
with other liquid, water is called the solvent. “The maxi¬ 
mum quantity of the solute that a given amount of the 
solvent can contain in the presence of an excess of the 
solute is the solubility of the substance.” With most 
solids the solubility is increased by heat. Certain sub¬ 
stances are insoluble in water and easily dissolved in 
alcohol. 

Saturated solutions are solutions which contain all the 
solute that can be held in solution at an ordinary tempera¬ 
ture. In a supersaturated solution a certain amount of 
the matter to be dissolved settles down in solid particles. 
This deposit is known as the precipitate. 

The freezing- and boiling-points of solutions suggest in¬ 
teresting chemical processes that can be widely illustrated 



172 


ELEMENTARY CHEMISTRY 


by experiments, with results that are common knowledge; 
for example, the custom of sprinkling salt on walks coated 
with ice or snow. 

Deliquescence is the condition of becoming liquefied by 
the absorption of moisture from the air. Substances 
known as deliquescents should be kept in air-tight pack¬ 
ages. 

Efflorescence .—Certain crystalline salts lose their crystal 
form and become a powder when exposed to the air. 
This process is termed efflorescence. 

Effervescence is the term applied to the commotion in a 
fluid produced by chemical reaction, in which some part 
of the mass escapes in gaseous form, producing small 
bubbles. The chemical reaction which takes place when 
the two parts of a seidlitz powder are dissolved separately 
in water and mixed is a familiar example. Ginger-ale 
and soda-water illustrate a process in which the liquid is 
charged with carbon dioxid under pressure. The carbon 
dioxid escapes when the pressure is reduced. 

The large number of inorganic or mineral compounds 
may practically all be included in one of three great classes 
—acids, bases, and salts. Not all acids, however, come 
from minerals. Some of the most commonly used acids 
come from the animal and vegetable kingdoms. Acids 
manifest a special affinity for water. They are sour sub¬ 
stances, all easily dissolved in water. The oxidation of an 
alcohol produces an acid. Important characteristics of 
acids are a sour taste, the power of neutralizing alkalies, 
and of changing the color of blue litmus-paper red. Most 
acids are powerful decomposing agents. 

The litmus test is one of the simplest and most commonly 
used tests to determine the presence of acid in a sub¬ 
stance. Litmus is a blue-colored substance or pigment 
secured from a plant, the lichen, found on trees and cliffs. 
Litmus paper is paper which has been soaked in litmus. 
It is turned red by any acid. In the absence of acid it is a 
purplish blue. Acids have an important part in the work¬ 
ing of the different parts of the body. The stomach 


SOLUTIONS, ACIDS, BASES, AND SALTS 173 

juices on which the digestion of food largely depends al¬ 
ways contain a certain proportion of hydrochloric acid. 

Acetic add gives to vinegar its sour taste. It is de¬ 
rived chiefly from alcohol as the result of fermentation. 

Citric add is found in large proportion in such fruits as 
lemons, oranges, grape-fruit, limes, etc., and in smaller 
quantities in berries and currants. 

Malic add is found chiefly in apples, pears, rhubarb, 
and the smaller fruits. 

Tartaric add is found chiefly in grapes. 

Oxalic acid is found chiefly in rhubarb and in the plant 
called oxalis or sour-grass. It is strongly poisonous. It 
is used in photography and for removing ink, rust, and 
other stains. 

Lactic add is produced by the fermentation of milk- 
sugar. It is the acid found in sour milk. Lactic acid 
ferment is present in “lactone” and other tablets used to 
produce artificial souring of milk. 

Butyric acid gives to butter its characteristic flavor. 

Bases and Salts.—In chemistry the term base is applied 
to the non-acid part of a salt, or to the substance which 
combines with acids to form salts. The most important 
property of the bases is their ability to neutralize acids. 
They are formed by the combination of some metal with 
water, and play an important part in the intricate chemical 
processes of the body. 

The terms bases, hydroxids, and alkalies are often used 
interchangeably, though there are certain differences be¬ 
tween bases and alkalies. In general, an alkali is a 
soluble base. 

An alkali is one of a class of compounds which form 
salts with acids and soaps with the fats. Important bases 
are ammonium hydroxid or ammonia-water, potassium 
hydroxid or caustic potash, sodium hydroxid or caustic 
soda, calcium hydroxid or slaked lime, magnesium hy¬ 
droxid, used in making milk of magnesia, and ferric 
hydroxid. 

The action of alkalies on fats resulting in soaps, cleaning 


174 


ELEMENTARY CHEMISTRY 


powders, etc., makes them useful for cleansing purposes. 
Alkalies and acids neutralize each other, but, owing to 
their strong irritative and corrosive effects, both have 
decided limitations which should be understood and 
observed. 

Salts are substances resulting from the action of an 
acid on a base or metal. They are usually neutral in 
reaction, producing no change in litmus. As salts are 
formed by the union of an acid with a metal, different 
combinations of acids with metals form different salts. 
Hydrochloric acid forms chlorids, sulphuric acid forms 
sulphates, nitric acid forms nitrates, carbonic acid forms 
carbonates, phosphoric acid forms phosphates. 

Salts have no true nutritional value, but are indis¬ 
pensable elements in our diet, and play a very important 
part in maintaining the health of the body. 

The most abundant salt in nature is sodium chlorid or 
common salt. Potassium chlorid is similar in composition 
to sodium chlorid, and is used largely in the manufacture 
of fertilizers. 

Ammonium chlorid or sal ammoniac is used widely in 
various industrial processes. In medicine it is classed as 
an expectorant. 

Incompatibilities.—In chemistry certain elements and 
compounds refuse to mix with other substances without a 
chemic change being brought about. There is also a 
physiologic incompatibility which needs to be observed 
which makes it undesirable to administer one remedy with 
a certain other remedy because of their antagonistic 
effects. (See Poisons and Antidotes, page 341.) 

EXPERIMENTS 

1. Place a small crystal of copper sulphate in cold 
water. Now apply heat, and notice the change in the 
rate of solubility. 

2. Put about 10 c.c. of water in a flask and boil it. 
Insert a thermometer and observe the temperature. 
Place 2 gm. of common salt in the water and ascertain the 
boiling temperature of the solution. 


PHYSIOLOGIC CHEMISTRY 


175 


3. Test the following substances with litmus paper— 
vinegar, lemon juice, dilute solution of sulphuric acid. 

4. Test the following with litmus paper, both red and 
blue ammonia-water, lime-water, a solution of soda. 

5. Put about 5 c.c. of weak ammonia-water in an evap¬ 
orating dish, then add slowly dilute sulphuric acid until 
the litmus assumes a color intermediate between the red 
and the blue. During the addition of the acid stir con¬ 
stantly with a glass stirring rod. If you get too much 
acid, carefully add a drop or two of the base. Evaporate 
the solution almost to dryness, and observe the product. 
What is it? Test it with red and blue litmus. 


CHAPTER XVII 

PHYSIOLOGIC CHEMISTRY 

The human body when analyzed is seen to be a collec¬ 
tion of chemical substances which are constantly acting 
and reacting on each other. These chemical substances 
are taken into the body through the mouth and through 
the lungs, in the form of food, drugs, or poisons, or as 
oxygen from the air. Every substance swallowed is 
composed of chemical elements, which, when they enter 
the body, react with one another and with the tissues. 
The chief chemical constituents of the body are oxygen, 
hydrogen, carbon, nitrogen, calcium, phosphorus, and 
sulphur. Sodium, chlorin, potassium, iron, magnesium, 
and silicon are also present in small quantities. 

The study which biologic chemistry, the chemistry of 
life, has received in recent years has contributed greatly 
to a clearer understanding of the normal processes of the 
body, and also to the changes produced in the body which 
result in disease. 

Metabolism is the term used to indicate the change pro¬ 
duced in a substance by the action of living cells upon it. 
It is the process by which living cells or organisms in¬ 
corporate the elements obtained from food into a part of 
their own bodies. Various diseases, such as diabetes, 



176 


ELEMENTARY CHEMISTRY 


gout, uremia, etc., result from disturbance in some of 
the chemical processes of the body. 

Food materials are necessary for the building and re¬ 
pairing of the tissues of the body, for the production of 
heat and energy or power, and for the regulation of the 
physical processes. Foods may be roughly divided into 
three great classes, according to their chemical constit¬ 
uents—body builders, fuels, and body regulators. The 
following table 1 illustrates the classes into which common 
food substances are ordinarily grouped, and the sources 
from which food elements are obtained: 

I. Body Builders.— (a) Muscle formers (protein): 

Milk and cheese. 

Eggs. 

Lean meat. 

Nuts. 

Legumes. 

(b) Bone formers: 

Milk. 

Cereals. 

Vegetables. 

(c) Blood formers: 

Water and beverages. 

Fruits. 

Vegetables. 

Eggs. 

II. Fuels. — (a) Fats and oils: 

Butter. 

Cream. 

Olive and other oils. 

Nuts. 

(b) Starches: 

Cereals. 

Potatoes. 

(c) Sugars: 

Sugar-cane, beet, and maple. 

Fruits. 

Sweets. 

(d) Muscle formers (safhe as above). 

III. Body Regulators. — Bulk ( cellulose): 

Bran and whole cereals. 

Coarse vegetables. 

Fruits. 

Whole cereals. 

1 From “Good Health Magazine.” 


PHYSIOLOGIC CHEMISTRY 


177 


Another form of food classification is into proteins, 
carbohydrates, fats, minerals, and water. 

Vitamins. New light which has been thrown on defi¬ 
ciency diseases and on malnutrition in general has em¬ 
phasized the importance of certain accessory factors in 
diet, called vitamins, which seem to have an important 
part in nutritive processes. These elements are essential 
to growth, and the absence of vitamins from the diet is 
believed to be largely responsible for such diseases as 
beriberi, scurvy or rickets, pellagra, etc. Green vege¬ 
tables, such as cabbage, carrots, etc., fruits, and certain 
cereals are relatively rich in vitamin substance. 

The term protein is used to include the principal nitrog¬ 
enous compounds whether of animal or vegetable origin. 

Carbohydrates include all starches and sugars. 

Fats include both those of solid and liquid consistency, 
called oils, whether obtained from the animal or plant 
world. 

Digestion is defined as the process of changing foods into 
substances that will dissolve and pass through the walls 
of the alimentary canal into the body. 

The production of heat is one of the important offices 
of food. In order that the chemical processes of the body 
may be maintained without disturbance, a certain degree 
of heat is necessary, and any prolonged variation from 
this normal temperature indicates disease. It is es¬ 
pecially important that there be no considerable or con¬ 
tinuous lowering of the temperature. Even a drop of 
one degree is a danger signal that should not be dis¬ 
regarded. 

Foodk, like all other organic substances, produce heat 
when they are burned. u Whenever a human being runs, 
walks, works, or studies he is enabled to do these things 
by burning up a certain amount of body fuel. When 
taken into the body, digested, assimilated, and used by 
the body, foods produce the same amount of heat as if 
burned outside of the body. 

“The Calorie .—If the heat-producing value of food can 

12 


178 


ELEMENTARY CHEMISTRY 


be reduced to terms of a standard measurement we have 
found a scientific unit of great value. This standard of 
measurement is termed a calorie. The calorimeter is an 
apparatus used for determining the caloric value of foods. 

“ A respiratory calorimeter has been devised to determine 
the caloric needs of the body. By means of such appara¬ 
tus it is possible to discover the requirements of the body 
for nutriment under different conditions of work and 
rest; the duties performed'by the different nutrients of 
food in supplying the needs of the body; and, finally, the 
nutritive value of food materials and the amount and pro¬ 
portions best adapted to the needs of people of different 
classes, with different occupations and in different condi¬ 
tions of life. ,, (Richards.) 

“The caloric needs of the body depend mainly upon 
activity and growth. ‘Activity’ includes both internal 
and external consumption of energy. It is most intense 
shortly after birth and grows gradually less toward old 
age, so that the infant a month or two old requires more 
calories per pound per twenty-four hours than ever again 
will be required. This, of course, is due to rapidity of 
growth in the early months. Growth is dependent upon 
rapid metabolism, and rapid metabolism requires a large 
amount of energy-producing food. Fifty calories per 
pound per twenty-four hours is required during the first 
three months of life; 45 calories per pound per twenty- 
four hours the second three months; and 40 calories per 
pound per twenty-four hours from the sixth to the twelfth 
month. This, of course, refers to the average healthy 
child. 

“Caloric needs for adults past the period of growth 
are figured mainly on occupation and weight. For in¬ 
stance, \ calorie per pound per hour while sleeping; f 
calorie per pound per hour while engaged in some 
light occupation while sitting, etc. Calories increase as 
activity of occupation increases. The method is very 
simple and approximately correct. Protein foods will 
be used to give about 15 per cent, of the total calories 


PHYSIOLOGIC CHEMISTRY 


179 


during growth, and 10 per cent, for persons past twenty- 
J 1e 1 ars . of a S c - The remainder of the calories are pro¬ 
vided by fats and carbohydrates, the latter always in ex- 
cess of the former.” (Cotton.) 


TABLE OF CALORIFIC VALUES. 

(After Frankland and Jurgensen) 
Calorific Value of 100 Grams in Calories: 

Egg, white of. 

Egg, yelk of. 


Apples. 66.00 

Arrowroot.391.20 

Asparagus. 18.50 

Bean soup.193.00 

Beef, boiled.209.00 

Beef, broiled.213.60 

Beef, fat.906.90 

Beef, lean... .156.70 

Beef, raw.118.95 

Bread crumbs.223.10 

Bread, wheat.281.00 

Bread, wheat, toasted.. .258.80 

Butter.814.00 

Buttermilk. 41.56 

Cabbage. 43.40 

Cakes.374.00 

Carp. 93.00 

Carrots. 41.00 

Cheese, Cheshire.464.70 

Chicken breast.106.40 

Cod-liver oil.910.70 

Cream.214.70 

Egg, hard-boiled.238.30 


Flounder. 

Flour. 

Macaroni. 

Mackerel. 

Milk. 

Milk, skimmed 

Oatmeal. 

Omelet. 

Pea-meal. 

Peas, green. 

Pigeon. 

Potatoes. 

Rice, ground. 

Salmon. 

Sugar, cane-. 

Trout. 

Veal cutlets, broiled 
Veal cutlets, raw... 

Whiting. 

Zwieback. 


. 67.10 
.342.30 
.100.60 
.393.60 
.352.60 
.178.90 
. 66.20 
. 39.61 
.400.40 
.236.70 
.393.60 
.318.00 
. 99.70 
.101.30 
.318.30 
. 133.30 

334.80 
. 106.40 
230.50 
142.45 

90.40 

357.80 


Digestive Fluids.—The exact chemical composition of 
the fluids of the body is important to be known in a great 
many of the disease conditions which nurses encounter. 
In previous chapters the composition of the blood and 
of urine was discussed. The digestive fluids have for 
many years afforded unlimited opportunity for research 
and experiment, and even yet the complex chemical proc¬ 
esses by which the elements in food become chemically 
changed in the body are not clearly understood. 

Enzymes are among the active substances by which 
many of the changes in food material are produced. 
Enzymes are defined as “protein-containing substances 














































180 


ELEMENTARY CHEMISTRY 


of unknown composition produced by living cells, both 
animal and vegetable.” Also as “complex chemic com¬ 
pounds capable of producing the transformation of some 
other compound. Most of the processes of both building 
and wasting in the animal body are controlled to some 
extent by enzymes. Each enzyme is able to work on one 
particular substance and on no other. On this account 
an enzyme has been compared to a key which will fit one 
particular lock, that is, will unlock one particular kind 
of molecule.” They are produced in the mouth, stomach, 
pancreas, and intestines. All contain protein, but their 
exact composition is not known. All can be destroyed by 
boiling. Most of the digestive enzymes work best at body 
temperature, some require an alkaline solution in which to 
work, others acid, while some will work in either an alka¬ 
line or acid solution. Every living cell contains enzymes, 
commonly termed ferments. 

Saliva is a mixture of secretions produced by the glands 
contained in the mouth. It is normally of a slightly al¬ 
kaline reaction, but varies from acid to alkaline under 
various conditions. It contains one important enzyme, 
known as ptyalin, which begins the process of digestion 
by its action on starchy substances. Ptyalin works best 
in an alkaline or neutral fluid, and its work can be quickly 
checked by acids. Acids are quite as powerful in their 
destructive effect on ptyalin as is boiling. 

The gastric juice is strongly acid in reaction, due to the 
presence of hydrochloric acid. The percentage of hydro¬ 
chloric acid is variable. During digestion it is estimated 
at from 0.3 to 0.5 per cent. If this percentage is much 
lower or higher it interferes with the digestive process^ 
Much of the so-called dyspepsia is due to the secretion 
of too much or too little hydrochloric acid. 

Rennin and pepsin are the two important enzymes 
contained in the gastric fluids. Rennin coagulates milk— 
a condition necessary to digestion. It is difficult to 
separate from pepsin. 

Pepsin may be prepared for medicinal use by making an 
extract from the stomach glands of a pig. The com- 


PHYSIOLOGIC CHEMISTRY 


181 


mercial pepsin contains both pepsin and rennin It 
begins the digestion of proteins. 

Intestinal Digestion. When the stomach discharges 
its food contents partially digested into the intestine 
they are at once acted on by the pancreatic fluids secreted 
by the pancreas. The pancreatic juice contains several 
important enzymes, and because through these different 
enzymes it is able to act on starches, proteins, and fats it 
is frequently termed the most important of the digestive 
secretions. 

The bile secreted by the liver contains no enzymes 
but assists in the emulsion of fats and promotes absorp¬ 
tion. It also has an antiseptic action. 

Examination of stomach contents and feces is a neces¬ 
sary procedure in many forms of gastric and intestinal dis¬ 
turbance. Among the most important points to be de¬ 
termined are the amount of acid in a given quantity of 
the stomach contents, the presence of blood, and the 
length of time required by the stomach to empty itself 
after a test-meal or test-food has been given. 

In the examination of feces the most important single 
point to be determined is the presence of blood. Large 
amounts of blood are quickly detected, but small traces 
ot blood are only discovered by careful chemical tests. 

The presence of undigested fat in the stools shows an 
interference with the work which bile performs in the 
digestive process. 

. The principal constituents of feces are food residue com¬ 
bined with digestive fluids, bacteria, dead and active, 
and a small proportion of waste substances due to me- 
tabolism. 

The chemical constituents of urine are necessary to be 
known in practically all disease conditions, since the 
kidneys are the chief excretory organs of the body, 
and are largely depended on to filter from the blood the 
waste products caused by the burning of nitrogenous 
food elements. They also assist in the elimination of 
superfluous salts, thus maintaining a proper salt balance, 
and, in general, are expected to rid the body of various 


182 


ELEMENTARY CHEMISTRY 


other poisonous substances manufactured in and by the 
body. 

Urine is composed of urea and uric acid, both of which 
are nitrogenous substances, various salts, dissolved gases, 
with a relatively large amount of water. (See chapter on 
The Urinary System, page 112.) 

The Chemistry of Cooking.—In cooking, raw materials 
in the form of food substances are changed by the action 
of heat into substances more palatable and more easily 
digested. Certain substances become partly digested in 
the cooking process. 

Solution occupies a large place in the chemistry of 
cooking and digestion. In fact, it is often stated that 
1 ‘digestion is primarily synonymous with solution. All 
solid food materials must become practically soluble before 
they can pass through the walls of the digestive system. 
Starch must be transformed into soluble crystalline sub¬ 
stances before absorption can take place. Cane-sugar has 
to undergo a chemical change before it can be absorbed. 
(See chapter on Principles of Nutrition, page 353.) 

The general principles on which the conversion of starch 
into sugar and sugar into alcohol is brought about 
afford an interesting line of experiment for students of 
elementary chemistry. 

Starch Conversion .— (( There are two distinct means by 
which starch conversion is produced. One is by the use 
of acid and heat, which changes the starch into sugar, 
but can go no further. The other is by the use of a class 
of substances called ferments, some of which have the 
power of changing the starch into sugar, and others of 
changing the sugar into alcohol and carbon dioxid. 
These ferments are in great variety, and the seeds of some 
of them are always present in the air. Among the chem¬ 
ical substances called ferments, one is formed in sprouting 
grain, which is called diastase or starch converter, which 
first, under the influence of warmth, changes the starch 
into a sugar, as is seen in the preparation of malt for 
brewing. The starch first takes up water, and under the 
influence of the ferment is changed into maltose. Cane- 


PHYSIOLOGIC CHEMISTRY 


183 


sugar is readily converted into two sugars, dextrose and 
levulose. (Richards.) 

The production of flavors in foods and beverages on 
which so much of the enjoyment of food depends is due 
to subtle chemical changes not clearly understood but 
unmistakable in results. A hundred familiar illustra¬ 
tions could be given. For example, study the change 
produced in the coffee berry by roasting. Under the in¬ 
fluence of heat a chemical substance existing in the berry 
is broken up and new chemical compounds are produced. 
Too much or too little heat adversely affects the process 
by which the desired compounds which give the right 
flavor are produced. The same 'thing occurs in the toast¬ 
ing of bread, the roasting of meat, corn, etc. The chemis¬ 
try of cooking is to a large extent the chemistry of flavor 
production—the application of heat to the food material 
m such a way as to bring about the right changes and 
only these. 

EXPERIMENTS 

1. Conversion of starch to glucose: Boil 5 grams of 
cornstarch with a weak solution of sulphuric acid. From 
time to time test by adding a drop by means of a stirring 
rod to a drop of tincture of iodin in an evaporating dish. 

2. Upon some starch paste put a quantity of saliva. 
Let stand and test every few seconds, as in 1. 

3. Digestion of proteins: In a test-tube put J gram of 
white of egg and 10 c.c. of an acidulated pepsin solution. 
Keep warm and let stand for several days. Note result. 

4. Note the result of commercial rennet on milk in the 
preparation of junket. 

5. Digestion of fats: To 10 c.c. of milk in a test-tube 
add 3 c.c. of fresh pancreatin extract obtained by grinding 
a few grams of fresh pancreas in a mortar and adding a 
little water. Keep the tube warm and test from time to 
time with blue litmus paper. 

6. Testing urine: Fill a test-tube half full of urine. 
Apply a flame to the top of the liquid until boiling takes 
place. If the liquid becomes turbid and this does not 


184 


ELEMENTARY CHEMISTRY 


disappear when a drop of nitric acid is added, it indicates 
the presence of albumin. 

7. Test for presence of glucose by taking equal parts of 
urine and Fehling’s solution and boiling together. If 
sugar is present there will be a characteristic color change. 


CHAPTER XVIII 
CHEMISTRY AND CLEANING 

In the discharge of every-day household duties every 
individual is performing more or less complex chemical 
experiments. “Every match that is lighted, every use 
of soap on the body, the clothing, or utensils, depends 
upon chemical laws for the reactions which take place. 
Therefore, to some extent, every house is a laboratory. 
An understanding of simple chemical reactions tends to 
economy in household management.’ (Richards.) 

Most household laboratories are supplied with alkalies 
in the form of concentrated lye, used for removing grease 
from drain pipes and for making soap; sodium carbonate, 
or sal soda, common washing soda, used for softening hard 
water; sodium bicarbonate or baking soda, used to neu¬ 
tralize acids in cooking; borax, also used to soften hard 
water and as a bleacher and antiseptic; ammonia, used in 
a variety of cleaning processes; soap in cakes, chips, or 
powder, also in semiliquid (soft soap) and liquid form. 

Adds in the form of vinegar (acetic acid), sour milk 
(lactic acid), and lemons, oranges, etc. (citric acid) enter 
largely into every-day diet, while various acids are used 
in cleansing and bleaching processes. 

The effects of various chemicals on the substances to 
be cleansed should be understood and observed. Many 
of them have a violent corrosive effect which will destroy 
metals or eat holes in a fabric unless the chemical is 
thoroughly washed out or neutralized by another chemical 
of an opposite nature. 

Dust and Dirt.—The removal of dust and dirt consti¬ 
tutes a considerable part of the daily labor of civilized 



CHEMISTRY AND CLEANING 


185 


human beings. Dust has been defined as “earth or other 
matter in fine dry particles so attenuated that they can 
be raised by the wind.” Dust when analyzed contains 
mineral matter, animal waste, and vegetable debris, 
but it contains another ingredient which, from a sanitary 
standpoint, is more important than any other. It con¬ 
tains minute vegetable organisms known as bacteria, 
yeasts, and molds, commonly spoken of as germs, but 
they are capable of developing into growing forms. 
Most are plants belonging to the fungi. In their manner 
of life they are essentially like the plants we see, requiring 
food, growing, and reproducing their kind. They require 
moisture in order to grow or multiply, but, like the seeds of 
higher plants, can take on a condition calculated to resist 
hard times and endure these for long periods; then when 
moisture is furnished they immediately spring into growth. 

“It is recognized that the air everywhere contains the 
spores of molds and bacteria, and it is this dust carried in 
the air which falls in our houses and constitutes an enemy 
to health.” (Richards.) All bacteria, yeasts, and molds 
are not harmful. The majority are friendly to health, and 
work continuously to produce the chemical changes on 
which animal and vegetable life depends. (See page 188.) 

The mixture of dust with grease and with sugary 
or smoky deposits adds greatly to the problem of clean¬ 
liness. To combat these compounds, which we recognize 
as dirt, a great variety of chemical mixtures have been 
worked out, different materials requiring different chem¬ 
ical products to render them clean and wholesome. The 
fact that the greasy film combined with dust settles on 
materials of widely different character—wood, metal, 
minerals, leather, paper, fabrics, etc., each requiring the 
use of special chemicals—has presented a great variety 
of chemical problems and opens a wide field for the young 
student's experiments. The inflammable nature of many 
of the chemicals used in cleansing should be borne in mind. 

Paints and Varnish. —The care and cleaning which these 
substances receive determine to a considerable extent their 
beauty and durability. The use of the wrong kind of 


186 


ELEMENTARY CHEMISTRY 


chemical on paint or varnish often effectually removes 
it and mars an otherwise beautiful surface. A familiar 
example of this sort of chemical reaction is seen when a 
piece of wet laundry soap is left on a varnished table. 
The effect of heat on a varnished surface is equally disas¬ 
trous. The exact cause of these effects can be shown by 
a variety of chemical experiments. 

Poisons and Antidotes.—Many of the commonly used 
cleaning substances, disinfectants, etc., are strongly 
poisonous when taken into the body. A solution of bi- 
chlorid of mercury, one of the commonest disinfectants, 
given by nurses in mistake for a dose of a solution of mag¬ 
nesium sulphate (Epsom salts) has been the cause of 
numerous deaths in hospitals. Too strong solutions of 
carbolic acid, corrosive sublimate, etc., burn the tissues 
if they do not cause death. 

Because a nurse is constantly handling and using power¬ 
ful chemical substances every nurse should study to be 
extremely careful in reading labels, and should familiarize 
herself with the antidotes for the strongly poisonous 
drugs in common use in hospitals. (See page 341.) 

SUGGESTIONS FOR EXPERIMENTS 

1. Try to remove iron rust stains from a piece of cloth 
with hydrochloric acid. Note the effect on the cloth if 
the acid is left in the fabric; also, if after using the acid, 
the cloth is washed in weak ammonia-water. 

2. Remove an ink spot by the use of a solution of oxalic 
acid. After stain is removed be sure the acid is washed 
from the fabric. 

3. Use a little turpentine to remove a paint stain. 

4. Try borax and cold water on a chocolate stain. 

5. Note the stain produced by a drop of nitric acid on 
the skin. The skin is protein, and this action is often 
used as a test for the presence of protein matter. 

6. As acid and alkali are opposed in their effect, note 
by means of litmus paper the counteraction of lime-water 
and soapsuds upon any acid poison, and of lemon-juice 
or dilute vinegar upon ammonia-water or lye. 


NOTES 


NOTES 


NOTES 


NOTES 


SECTION III 

HYGIENE 


CHAPTER XIX 

GENERAL HYGIENE 

Hygiene is defined as that department of sanitary 
science which treats of the preservation of health. The 
goddess of health, Hygeia, of Grecian mythology, was the 
daughter of iEsculapius, the god of medicine. Hygiene 
is probably the oldest of the sciences. The Levitical 
code given by Moses provided definite regulations as to 
methods of preventing disease among the ancient 
Israelites—duties which were to be observed as a part of 
their religious rites. Imperative directions regarding 
cleanliness, food, the isolation of persons affected with? 
certain diseases, and the methods of cleansing to be 
employed after the disease had spent itself, are contained 
therein. The science of hygiene, as we know it to-day, 
is the result of the evolution of centuries of thought and 
study as to the best methods of preventing disease and 
accident, and thereby preserving health. 

Health has been defined as “perfect circulation of the 
blood and perfect elimination of the waste products 
from the blood.” 

“Health is the faculty of performing all actions proper 
to the human body in a perfect manner.” 

“Health is the perfect circulation of pure blood in a 
sound organism.” 

Requirements for Health.—How to preserve this 
condition is the object of the study of sanitary science 

187 



188 


HYGIENE 


or hygiene. To keep the body in health requires for it 
a proper proportion of air, water, food, exercise, and 
rest. No individual can expect to continue in health 
when deprived of a just proportion of any of these phy¬ 
siologic requirements. 

A general and thorough study of hygiene would include 
the home or habitation in which an individual dwells; 
the soil and surroundings; the methods of providing 
warmth and light; the air he breathes; the food and water 
he uses; the clothing he wears; the proper disposal of the 
excreta of the body and other refuse; his habits of exercise 
and rest, his occupation, and the common causes of dis¬ 
ease, especially of preventable diseases. 

Friends and Enemies of Health.—The maintenance 
of life and also the diseases commonly classed as pre¬ 
ventable have both been found to be dependent on the 
activity of minute organisms which are invisible to the 
naked eye, which are commonly known as bacteria or 
germs. These may be divided into two main classes: 
those which are friendly to life and health and those 
which are destructive. Animal life is dependent on 
vegetable life. Vegetable life is dependent on certain 
qualities in the soil, each blade of grass and plant appro¬ 
priating from the elements of the soil the material needed 
for its growth. If the earth is to continue to produce 
the vegetation on which animal life depends, the elements 
drawn from it by plants must in some way be restored 
to it. The restoring of these elements is dependent on 
these little invisible friends, the germs. Through their 
increasing activity dead plant and animal matter is 
disintegrated, broken up into simple elements, to be 
again absorbed by the earth and again used to produce 
vegetation. 

These good germs are the scavengers of the earth, 
feeding on dead waste matter and rendering harmless 
many objects which would otherwise be destructive to 
life. 

Disease-producing germs exist always at the expense of 


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Nurses should make it clear to Parents, etc., that mildness of the attack in one person does not lessen the chances of another taking the infection, or of having a virulent type of the disease. ’From Hygiene for Nurses, Herbert W. G. MacLeod, B. Sc., M D 





































































t*r >'f. f n» • i '<{'.‘1 ■ ' 


















. 



























GENERAL HYGIENE 


189 


some living creature. They are commonly classed as 
pathogenic organisms, pathogenic bacteria, or parasites. 
In various ways they gain an entrance to the human sys¬ 
tem, take from it substances necessary to health, and 
produce within the body substances poisonous to the 
tissues of the part attacked by them. 

These germs require for their life and development 
warmth, moisture, and material on which to feed. They 
may gain entrance to the body and accomplish no harm 
because the natural resistive powers of the body are 
sufficient to overcome them or to hold them in check. 
If the resistive power is lowered from any cause and 
there is not sufficient vigor to overcome the bacteria, 
the latter create in the body a form of poison known as 
ptomains or toxins. 

The Spread of Disease. —Among the common methods 
by which pathogenic germs are spread are: 

1. By means of dust the germs may, when dry, be 
distributed through the air. 

2. By being washed over the surface of the earth or 
by filtering through the ground they may infect the 
water supply, (It is claimed, however, that disease 
germs are rarely found lower in the earth than 5 or 6 feet, 
certain elements in the earth having the power to destroy 
them in course of time.) 

3. By means of flies they may be deposited on food 
or drink. 

4. By means of clothing, soiled boots, or animals. 

5. By direct contact through handling. 

6. By means of mosquitoes. 

AIR 

Air is the most immediate necessity of life. It consists 
of oxygen, nitrogen, carbonic acid, ozone, mineral salts, 
organic matter in varying proportions, and a variable 
amount of watery vapor. The proportion of the first 
three gases which compose the bulk of the ordinary air 
is said to vary very little in different parts of the world. 


190 


HYGIENE 


Ozone is said to be generally absent from the air in 
cities. The purest air is found on high mountains and 
over the sea. 

Contamination of Air.—Air is contaminated by the 
breath of men and animals; by the decomposition of 
animal and vegetable substances; by combustion of coal, 
gas, etc., and by various manufacturing industries. 
In the ordinary air there is always a certain amount of 
suspended matter consisting of minute particles of sand, 
soot, wool, decomposed animal and vegetable matter 
mixed with germs, good and bad—in fact, particles of 
almost every conceivable thing. In mining districts or 
manufacturing towns the air is usually loaded with par¬ 
ticles of mineral matter. 

Purification of Air.—Nature has arranged for the 
purification of the air, provided man does his part or does 
not thwart her in her efforts. This is accomplished by 
the winds, which bring pure air and carry away impur¬ 
ities; by rain, which cleanses the air by carrying down 
with it the suspended matter and depositing it on the 
earth; by the chemical action of oxygen and ozone on 
the impurities; and by the power possessed by the vege¬ 
table creation of absorbing carbonic acid gas and giving 
off oxygen. If these natural forces are not impeded, 
the composition of the air will remain uniformly pure. 

Oxygen is the constituent most important for the 
animal world, carbonic acid for the vegetable world. 
Without a certain proportion of oxygen life cannot be 
maintained. The blood is purified by its contact with 
oxygen in the lungs, hence, unless oxygen is supplied 
the blood must retain its impurities. 

The purity of air in living rooms chiefly depends on 
the provision made for the escape of foul air, for the 
entrance of abundance of fresh outside air, and the 
amount of space for each individual. Each person is 
throwing off organic matter from the skin and vapor 
from the lungs, which, if not allowed to escape, quickly 
vitiates the air. The burning of gas and coal rapidly 


GENERAL HYGIENE 


191 


exhausts the oxygen in the air and leaves instead injurious 
gases. The locality and sanitary surroundings also 
affect the quality of the air. Filth, in the form of decom¬ 
posing animal or vegetable matter, or the gases arising 
from damp marshy ground, will rapidly load the air with 
impurities and make it a menace to health. 

Scientists have shown that about 3000 cubic feet of 
pure air per hour should be supplied for each person. 
The organic matter thrown off in the exhalations from 
the body tends to collect in the lower strata of air and a 
certain amount of floor space is necessary. The height 
of a room does not make up for deficiency in floor space. 

Ventilation may be either natural or artificial. 

Natural ventilation in houses is accomplished by means 
of doors, windows, and the cracks and crevices around 
the skirting boards, window-sashes, etc. An open 
fireplace provides for the escape of impure air, but some 
other opening is necessary for the admission of pure air. 
If a proper distribution of air is to be accomplished and 
draughts prevented, fresh air should be admitted from 
above the head. Good ventilation requires that the 
incoming air shall penetrate into all parts of the room 
and combine with the air already present. A strong 
draught or air current may pass through a room, affect 
only the air between the points of inlet and outlet, leaving 
the air in other parts of the room unchanged. It is an 
important part of a nurse’s duty, whether in hospital or 
home, to see that her patients are supplied with an 
abundance of clean air, and no amount of energy expended 
in maintaining cleanliness in other directions can compen¬ 
sate for carelessness in this matter, which concerns a 
vital necessity to health and life. In the hospital the 
nurse will probably be charged with the adjustment of 
ventilators as well as the regulation of the natural means 
of ventilation and the protection from draughts. In a 
home she may have to improvise her own methods of 
ventilation. One of the simplest methods of securing 
good and constant ventilation where no ventilating flues 


192 


HYGIENE 


are provided is by placing a 2-inch board underneath the 
lower sash of a window, thus admitting a constant supply 
of fresh air between the sashes and over the head, where 
it is readily warmed and diffused. A less desirable method 
is to cover the patient well, using a screen of some kind 
to protect from draughts, and open windows and doors 
two or three times daily, till the air in the room is thor¬ 
oughly changed. 

In cold weather it is important to maintain an even 
temperature where the sick are concerned, but this 
should not be secured by retaining impure air in the room. 
Florence Nightingale has said that “Of all methods of 
keeping patients warm, the very worst certainly is to 
depend for heat on the breath and bodies of the sick.” 
A thermometer indicating the temperature of the atmo¬ 
sphere is almost a necessity in a well-conducted sick 
room. It is not at all necessary, however, to chill a room 
in order to ventilate it, nor is coldness of the atmosphere 
in a room any sign of its purity. A room may occasionally 
be indirectly ventilated by filling an adjoining room 
with fresh air and opening a door, but whenever it can be 
accomplished without draughts or chilling the patient, 
direct ventilation is desirable. 

Ordinarily a temperature of 65° F. for a sick room will 
be warm enough, but in cases where the blood is impov¬ 
erished and the circulation poor, as it often is with aged 
individuals, a slightly warmer atmosphere may be 
necessary. Many cases, notably pneumonia and some 
forms of fever, rapidly improve under the influence of 
cold outdoor air, the improvement being attributed not 
solely to the abundance of fresh pure air, but to the 
coldness of the air, which seems to stimulate and energize. 
The subject of atmospheric temperature and ventilation 
is regarded as more important in the treatment of the 
sick than ever before, and due attention should certainly 
be given to the practical aspects of the subject by every 
nurse, whatever the class of patients she may be nursing. 

Artificial ventilat on is accomplished by extracting the 


GENERAL HYGIENE 


193 


impure air and forcing in pure air by mechanical methods, 
n this way the amount of air entering can be accurately 
regulated. It can be filtered, warmed, or cooled, accord¬ 
ing to the system of ventilation and machinery provided. 
It is, however, not considered wise, even with the most 
perfect ventilating system that has yet been devised, to 
ignore natural methods of ventilation entirely, and rely 
on machinery to do what Nature would do if allowed to. 

water 

Water forms about two-thirds of the weight of the body 
and is one of the prime necessities of life. In order to 
be wholesome for use in the body water should have the 
following qualities: 

It should be transparent and without color. 

It should have no particles suspended in it. 

It should have neither taste nor odor. 

It should be aerated. 

It should be free from pathogenic germs. 

It has been found that water may possess the first 
four qualities and still be exceedingly unwholesome. 
In other words, clearness of water is no guarantee of its 
purity. It has been found that water which looked clear 
as crystal contained enough typhoid fever germs to 
infect a whole village. 

Sources of Water-supply.—The natural sources of 
water are the rain and the snow. A portion of this water 
that falls evaporates, another part sinks into the earth, 
and the remainder flows off the surface to swell the rivers 
and other bodies of water. 

Water is a combination of hydrogen and oxygen. It 
freezes at 32° F. and boils at 212° F. All natural waters 
contain a certain proportion of mineral salts, notably 
lime. They are said to be hard or soft, according to the 
amount of mineral salts contained. 

Contamination of a water-supply may take place from 
drainage from barnyards, cesspools, closets, sewers, 


194 


HYGIENE 


surface soakage, or by moulds, ferments, or decaying 
animal or vegetable matter of any kind. 

Purification is effected in various ways. The soil 
acts as a natural filter. Spring water issuing from its 
depths is usually pure and wholesome, unless passage 
through limestone deposits has rendered it too hard. 
Oxygen exists abundantly in the soil and serves the 
purpose of destroying decaying animal and vegetable 
matter which may soak in from the surface. 

Distillation is said to more completely purify water 
than any other method used. It is largely used at sea. 
Most large steamships have a condensing apparatus for 
producing distilled water from sea-water. It needs to be 
aerated before being used. 

The boiling of water diminishes the “ hardness due to 
mineral salts; the carbonic acid and other volatile gases 
which have been dissolved in the water are driven out 
and the mineral substances deposited in the bottom of the 
vessel. Excess of mineral substance in water may cause 
digestive disturbance, and is believed in some cases to have 
exercised a decided influence in causing calculous diseases. 
Regarding the purifying of water, Parkes says: We 

have the strongest reason for believing that distillation 
and boiling effectually destroy all organized living matter 
in the water except the spores of some bacteria. There 
can be little doubt but that the specific poisons of cholera, 
enteric fever, and of other diseases occasionally propo- 
gated by means of impure drinking water are effectually 
destroyed by even a few minutes’ boiling.” 

Chemical purification of water is sometimes attempted, 
but the methods employed are rarely reliable. Alum, 
about 6 grains to the gallon, is often used where the water 
is muddy or turbid. It precipitates the suspended earthy 
substances, but does not destroy disease germs. Per- 
chlorid of iron and potassium permanganate are also 
used for the same purpose. 

Filters, especially domestic filters, are useful for clearing 


GENERAL HYGIENE 


195 


the water of floating particles, but experiments have 
proved that they are often a source of pollution of water 
rather than of purification. The filter that will run fast 
is usually the favorite. So long as the water will flow 
through it at a satisfactory speed it is rarely cleaned. 
Its pores become clogged with putrefying matter. What¬ 
ever is taken out of the water stays in the filter till it is 
cleansed, and it is not at all unusual to find, on examining 
filtered water for bacteria, that it contains many times 
more the number of disease germs than unfiltered watei 
from the same main source. “Put not your trust in 
filters’^ is a good rule to observe if there is reason to 
believe that drinking water contains disease germs. 

Diseases Produced by Impure Water.— Certain 
forms of dyspepsia and diarrhea are often produced by 
excess of mineral salts in water, especially in those 
unaccustomed to it. The most common diseases attri¬ 
buted to an impure water-supply are typhoid fever, 
dysentery, and cholera. Diphtheria and tuberculosis 
may be carried by water. Metallic poisoning occasionally 
occurs by the use of water polluted with refuse from 
mines, and from absorption of metals used in pipes and 
tanks. 

Excessive drinking of water is sometimes ascribed 
as a cause of disease, but, if taken at the right time, it is 
rare that pure water will cause harm. Too much mineral 
water may cause trouble from the excess of the mineral 
element. By far a greater amount of disorder is caused 
by taking too little water. The human machinery is very 
liable to become clogged by its own waste products if 
plenty of water is not supplied for the cleansing of the 
tissues. 

Ice .—The idea that water purifies itself in freezing is 
no longer accepted. It has been proved again and again 
that disease germs may live in a dormant state in ice 
for months, and many epidemics of disease have been 
caused by the use of polluted ice. 


196 


HYGIENE 


FOODS 

The study of foods will be taken up more fully in the 
lessons on dietetics. The subject of “pure foods” is one 
that is receiving a vast amount of attention from scientists 
and from the general public, and the nurse is urged to 
avail herself of the current literature on the subject. 
Overeating is regarded as one of the very common causes 
of disease. When too much food is eaten, the digestive 
organs are unable to satisfactorily deal with it. The 
undigested portion undergoes fermentation and putre¬ 
faction, owing to the bacteria always present in the 
intestines. Fetid gases are formed, and dyspepsia, 
diarrhea, and other digestive disorders are the result. 
Other symptoms are torpor, headache, fetid breath, 
fever, and hyperacidity of the stomach contents. The 
organs of elimination may, through overwork in attempt¬ 
ing to excrete an excessive amount of waste matter, become 
weakened or diseased. 

Deficiency in diet or of some of the necessary food 
elements tends to general debility, loss of body weight, 
anemia, and may predispose to rickets, scurvy, tubercu¬ 
losis, and scrofula. 

Milk is one of the most important and necessary of all 
foods. Being an animal product, its quality necessarily 
varies with the condition of the animal’s health and the 
general conditions surrounding it. The food supplied 
to the cow, the degree of cleanliness or filth maintained 
in securing and handling the milk, will determine to a 
considerable degree its quality. The germs of tubercu¬ 
losis and other diseases with which the bovine creation 
may be afflicted are liable to be produced in milk. Pure 
milk from a perfectly healthy cow may quickly become 
impure by careless handling. The washing of milk 
vessels in water containing the germs of typhoid fever, 
scarlet fever, and other diseases is a fruitful source of 
contamination. Milk forms an excellent food for germs 
as well as for human beings, and bacteria and other low 


GENERAL HYGIENE 


197 


forms of living organisms flourish in it. It also absorbs 
odors from being put in open vessels in the same refrig¬ 
erator with meat, fish, vegetables, etc. The proportion 
of fat or cream from the same cow will vary, but unscrupu¬ 
lous dealers are probably the most frequent cause of 
variation in cream. 

Adulteration. —Three principal methods of adulteration 
are practised: Water is added, cream is removed, and 
certain chemicals are added as preservatives. When 
water is added or cream is removed the nutritive value 
of the milk is lessened. The drugs most frequently 
used as preservatives are boracic acid, borax, salicylic 
acid, and formaldehyd. The injurious effects of chemic¬ 
ally preserved milk depend on the amount consumed 
and of the drug used. 

Where there is reason to suspect the purity of the milk, 
sterilizing or pasteurizing it is sometimes employed. 
Sterilizing or boiling the milk kills the germs, but is said 
to lessen its digestibility. Pasteurizing consists in 
subjecting the milk to a temperature of about 167° F. 
for a half hour and then quickly cooling it. It is claimed 
that by this process the injurious germs are destroyed 
and the digestibility is not lessened. 

Meat or flesh foods contain the same chemical elements 
as the human body and are, as a rule, more easily and 
completely digested than vegetable foods. Excess of 
meat eating, however, is blamed for deterioration in 
health in a great many cases by inability of the body to 
digest or appropriate the nutritive matter and of the 
organs of elimination to get rid of the waste products. 
Flesh foods are often the medium by which injurious 
parasites enter the body. Dangerous toxins or poisons 
may develop through the action of bacteria in meat. 
Ptomain poisoning may result from various foods, but 
putrefying or spoiled meat, poultry, game, milk, oysters, 
and fish are probably the most frequent causes. Metallic 
poisoning frequently occurs from the use of food cooked 
or allowed to stand in brass or copper vessels. It may 


198 


HYGIENE 


also be caused by the use of canned goods, either vegetable 
or meat, that have been kept too long in tin or that have 
been allowed to remain in the tin after opening. 

Meat, like milk, is an excellent material for the develop¬ 
ment of bacteria, and many cases of poisoning have 
resulted from sausages, meat pies, or partially decomposed 
or refuse meat which has been unaltered in taste. 

Vegetables which are boiled or otherwise cooked are 
usually safe forms of food, and the same is true of fruits. 
Vegetables which are eaten raw, such as celery, radishes, 
and lettuce, may in themselves be in good condition, 
but by being washed in contaminated water may become 
the medium for carrying infection into the system. 

Food adulteration is the addition of injurious sub¬ 
stances to food or the fraudulent use of cheaper articles 
than the one represented. Many of these adulterations 
are not injurious in their effect on health. Milk is an 
important exception to this latter statement. The foods 
most frequently adulterated are butter, canned goods, 
flour, coffee, minced meats, milk, preserved fruits, spices, 
and syrups. The methods of adulteration are exceedingly 
varied and need not be entered into here. 


GENERAL HYGIENE 


199 


CHAPTER XX 

GENERAL HYGIENE ( Continued ) 

The location of a house or hospital, the nature of the 
soil on which it is built, and the general surroundings 
will very decidedly affect the health of its occupants; 
but the most wisely constructed and advantageously 
situated building may very soon become unsanitary and 
a breeding place for disease if daily sanitary precautions 
are not taken. 

The idea is generally accepted that a porous soil 
containing gravel or sand is the most desirable, if one. has 
a choice, and other considerations are equal. Such a 
soil is not favorable to dampness, which is always to be 
avoided in a location if possible. It is believed that 
dampness predisposes to many forms of disease, especially 
diseases of the respiratory organs and rheumatism. 
An elevated position favors natural drainage. A low, 
marshy soil should be avoided. 

While a certain amount of shade is desirable around a 
dwelling of any kind, yet too many trees prevent the 
entrance of sunlight and air and tend to make a house 
damp—conditions which are all favorable to the develop¬ 
ment of disease-producing bacteria. 

The material used in the construction of a building 
is much less important than the habits of those who are 
to occupy it, so far as health is concerned. A shack 
may be rudely and cheaply constructed, but perfectly 
sanitary, a palace may be the opposite. In any building 
the provision made for disposing of refuse of all kinds is 
an exceedingly important consideration. 

Plumbing.—The plumbing system, the mode of in¬ 
stallation and care in the modern home and especially in 
a hospital, influences very materially the health of those 
who occupy the dwelling. The cost of repairs and upkeep 
of plumbing depends to a large extent on the general pre¬ 
cautions and care observed in the daily routine. 


200 


HYGIENE 


“There are eight points to be observed in plumbing 
installation, viz.: 

“(1) System should be simple, compact, easily accessible 
for cleaning, inspection, and repair. 

“(2) It should be properly proportioned and so designed 
as to make it self-cleansing. 

“(3) System should be properly trapped and ventilated. 
Each fixture should be provided with a trap. 

“(4) System should be gas-and water-tight. 

“(5) System should be free from movable mechanical 
devices which would be liable to get out of order. 

“(6) Fixtures should be made of non-corrosive and non¬ 
absorbent material, and free from movable mechanical 
devices. 

“(7) Fixtures should be located in well-ventilated and 
lighted rooms and should be set in the open. 

“(8) An adequate supply of water to properly and 
thoroughly flush fixtures and drainage system should be 
provided.” (C. A. Holmquist.) 

In every well-planned institution the drainage system 
which carries the waste from the building into the sewer 
should be carefully planned. The pipes should be large 
enough to carry the combined waste from the fixture, 
the joints should be water- and gas-tight and there “should 
be a slope in the main house drain in the basement of 
about \ inch to the foot in order that the flow will produce 
self-cleansing velocities in it and keep it from becoming 
clogged. The main drain should be provided with a trap 
to prevent sewer-gas from entering the system, and each 
fixture, such as sink, water-closet, urinal, etc., should be 
provided with' a trap to prevent sewer-gas from entering 
the rooms through the fixtures. Adequate provisions for 
ventilation should be made in systems of this type by 
carrying the soil and vent stacks through the roof of the 
house and providing the main drain with a fresh-air inlet.” 

“Traps.—Owing to the important part that traps play 
in plumbing systems the function and essential features 
of traps should be understood. As already noted, all 


GENERAL HYGIENE 


201 


plumbing fixtures should be provided with traps in order 
to prevent sewer-gas from entering the rooms through 
the fixtures. The traps should be placed as near the fix¬ 
tures as possible and they should be so located as to be 
readily accessible for cleaning. Traps in order to properly 
perform their function should be simple and durable; 
they should be self-cleansing and should not materially 
impede the flow through them. They should be so de¬ 
signed as to resist siphonage and back-pressure, and they 
should be free from movable mechanical devices that would 
be liable to get out of order. 

“Although there are a great many kinds of traps, they 
may for convenience be divided into two general types: 

(a) The siphon traps. 

(b) The non- or antisiphon traps. 

“Siphon Traps .—The simplest form of siphon trap is 
the running trap which consists of a downward bend in 
the pipe which when filled with water prevents the passage 
of air through the pipe. There are a number of forms of 
siphon traps, such as the D trap, the P trap, the S trap, 
including various modifications of them. These kinds of 
traps are not safe against siphonage unless properly back- 
vented, and should, therefore, not be used in the so-called 
one-pipe system of plumbing. 

“Non-siphon Traps .—These traps are so constructed 
that the seal cannot be entirely destroyed under ordi¬ 
nary conditions, provided, however, that the soil stack 
is carried through the roof and a fresh-air inlet is 
provided. The principal objection to this type of trap 
is that it is not always self-cleansing due to the large 
body of the trap. They have an advantage in that they 
are not easily siphoned and the large volume of water in 
the trap is not quickly evaporated. 

“Sewer-gas may also be admitted to a room through a 
fixture trap by back-pressure. This cannot occur, how¬ 
ever, if the soil pipe is carried through the roof and if the 
house drain is provided with a fresh-air inlet to relieve the 
pressure that would be caused by the discharge of a column 


202 


HYGIENE 


of water into a soil or waste stack or by gusts of wind from 
the roof. 

“Grease Traps. —In hotels, restaurants, and State In¬ 
stitutions where the wastes are rich in grease the sinks 
are usually provided with grease traps for the purpose of 
intercepting grease and preventing it from entering the 
drainage system and ultimately clogging it by the con¬ 
gealing of the grease on the sides of the pipes. The most 
efficient type is the so-called water-jacketed grease trap 
constructed with an outer compartment through which 
cold water circulates, causing the grease to congeal and 
rise to the top where it may be removed at regular in¬ 
tervals. The capacity of the grease trap is usually twice 
as great as the greatest amount of water that will be dis¬ 
charged into it at one time, so as to give the wastes time 
to cool and allow the grease to congeal before it reaches 
the waste pipe. 

‘‘Refrigerator Wastes.—Another class of wastes that 
should always receive special arrangement of piping is 
the refrigerator wastes. The waste pipe from a refriger¬ 
ator in which foods are kept should never be connected 
directly with] the waste or soil pipes, but should be dis¬ 
charged into an open sink provided with a trap in order 
to prevent sewer-gas from passing into the refrigerator 
if the trap should lose its seal due either to siphonage or 
evaporation.” (C. A. Holmquist, in “Albany Medical 
Annals.”) 

Stoppage in the plumbing pipes is likely to be found in 
the trap, and the traps are so located, as a rule, as to be 
readily investigated. Very frequently grease obstruction 
can be quickly removed by flushing the pipes with boiling 
water to which concentrated lye has been added. 

Snapping of plumbing pipes “is caused by excess pres¬ 
sure, lack of air chambers on the fixtures, or careless use 
of the valves. This snapping can usually be stopped by 
slightly and slowly opening and closing the nearest 
faucet.” 

General Care. —With ordinary care plumbing fixtures 


GENERAL HYGIENE 


203 


which are properly installed should need no important 
repairs for several years. In hospitals, where the plumbing 
system is much more complicated than in an ordinary 
house, much of the trouble and expensive repair work is 
made necessary because of the carelessness of some nurse 
or servant. Dropping of articles into the bowl of the 
water-closet is a fruitful cause of plumbing bills. Much 
trouble and subsequent expense would be avoided if a 
nurse who accidentally dropped an insoluble substance or 
article into the closet would promptly report the ac¬ 
cident and prevent the disastrous overflow. 

Dirt has been defined as 1 ‘matter out of place/’ but the 
conception of what constitutes dirt or filth is largely 
a relative one. The personal equation, training, and 
habits must enter largely into the definition with individ¬ 
uals. From a sanitary point of view, dirt may be said 
to be decomposing animal or vegetable matter and other 
matter involved with it. While this is matter on which 
the saprophytic germs are at work, effecting in it chemical 
changes, which will render it fit for use again in the scheme 
of vegetable life, it also furnishes conditions suitable for 
the life and development of disease germs, and there are, 
therefore, good reasons for the unceasing war with dirt. 

Flies are now known to be active agents in the spread 
of germ diseases, and, therefore, another reason is found 
in the fact that decaying matter of any kind attracts 
and feeds flies. The fly, by crawling over contaminated 
matter, gathers to itself disease germs, later to deposit 
them on food to be carried into the body and thus con¬ 
tinue the chain of infection. Because of their unceasing 
activities, flies are a far more dangerous kind of vermin 
than bedbugs in a house or hospital. 

Rats and mice have been found to be important 
factors in spreading the bubonic plague. 

Dust in a hospital may always be considered dangerous 
material. Under the microscope dust resolves itself 
into particles of soot, sand, iron and steel, glass, lime, 
woody fiber of vegetables—in fact, all manner of vege- 


204 


HYGIENE 


table matter, dried sputum, shreds of linen or wool from 
soiled bedding, pieces of hair, dried particles of pus, 
blood and human tissue, dried feces of horses, dogs, cats, 
and birds, crystals of urine, scales of skin, fragments of 
food of every sort, with disease germs of every kind. 
This is the material that floats in through the windows 
from the street to add to itself more disease germs from 
the centers of infection in the hospital wards; that is 
always floating in the air about us, though unnoticed; 
that settles on sterilized dressings and instruments as 
soon as they are exposed to the air; that mingles itself 
with the food; that is inhaled into the lungs of both sick 
and well if not properly and frequently removed; that 
is scattered over fruits, vegetables, candies, and other 
food wherever it is exposed for sale without covering. 
The nurse should need no argument to convince her of 
the relationship between dust and a great many forms 
of disease. 

Infection of Food in a Hospital Ward. —A recent 

writer 1 on the subject of hygiene in hospital wards has 
called attention to what every one knows is a common 
condition. He says: “Every one is alarmed at once by 
the knowledge that a person who is coming into daily 
contact with a case of typhoid fever is working in the 
dairy from which a milk supply comes; but there is 
certainly no common concern over the fact that in a very 
large proportion of hospital wards the general milk supply 
of the ward is being constantly drawn upon by nurses 
who at various times soil their hands through caring for 
the mouths, the persons, the excretions, and the bed¬ 
clothes of patients with typhoid fever, pneumonia., 
tuberculosis, and a variety of other infections.” He 
mentions an instance in which a nurse had assigned as 
her chief duties the preparation of liquid diets and the 
disinfection of excreta and bedclothes. He believes that 
diarrhea and other complications and secondary infections 
1 Edsall, in American Journal of Medical Sciences. 


GENERAL HYGIENE 


205 


occurring in typhoid fever in hospital patients are very 
frequently due to laxity or faulty hygienic methods. 
Whether or not this view is generally accepted, there 
is every reason why nurses should observe extreme care 
in their management of these duties, lest by any act of 
carelessness on their part any patient may be adversely 
affected. 

Sources of Infection.—In a large number of diseases 
the infectious matter is thrown off in the discharges from 
the throat and nose, while vomited matter in many cases, 
bowel discharges, urine, pus, and other discharges from 
wounds are capable of causing serious trouble if not 
carefully handled and promptly destroyed. 

Care of Ward Utensils .—The care of ward utensils and 
appliances, especially those used by patients having an 
infectious disease, is a matter of great importance in a 
hospital. Methods may vary according to facilities, but 
a nurse cannot too early learn that she has it in her power 
to do untold harm by simply being careless about what she 
may consider little things. 

Boiling of vaginal and rectal nozzles, catheters and 
tubes, sputum-cups, basins and instruments used about 
wounds, of syringes, etc., will always render such articles 
safe. An increasing number of hospitals are providing 
in hospital bath or service rooms facilities for boiling 
bed-pans and urinals also. Isolation of drinking glasses, 
dishes, and basins used by patients having communicable 
diseases should be carefully observed. Rubber sheets 
and pads can be subjected to thorough cleansing and 
chemical disinfection. Soap and water regularly and 
faithfully applied will keep shelves, racks, and service 
rooms in a sanitary condition. 

Bed and body linen from infectious patients can be 
subjected to chemical disinfection and, later, boiled as 
a part of the cleansing process. 

A solution that is highly recommended for the dis¬ 
infection of bed linen and clothing contains the following: 


206 


HYGIENE 


Carbolic acid. 3 parts. 

Common soft soap. 

Water.100 “ 

The clothing should remain in the solution not less 
than one hour, and whenever possible the solution should 
be hot when applied. 

To summarize: In a hospital ward infection may be 
communicated from one patient to another by the nurse 
through food; through the air by means of dust; through 
the hands of nurses and other attendants; through ther¬ 
mometers, dishes, instruments, basins, or other utensils 
used in common. 

Cremation of all garbage, soiled dressings, and refuse 
is the safest of all means of disposing of it. Whenever 
possible, utensils used for collecting such refuse should be 
exposed to live steam. If this is not available, careful 
daily cleansing and chemical disinfection should be 
practised. 

Sinks may be kept in a sanitary condition by observing 
thorough general cleanliness every day. In order to 
prevent pipes becoming clogged with grease, copious 
flushing at frequent intervals with a strong solution made 
of lye or soda carbonate with boiling water should be 
practised. Plenty of soap and boiling water act as 
disinfectants, and if faithfully and freely used, other 
disinfectants will rarely be needed. 

Chlorinated lime (popularly termed chlorid of lime) is 
a powerful deodorant and is useful for disinfecting hoppers, 
waterclosets, and such places. It should be used hot 
when possible and a strength of 4 per cent, is recommended 
by expert disinfectors. A solution of 1 per cent, by 
weight has been proved to disinfect typhoid stools in 
ten minutes. It is very essential that the lime used 
should be fresh. A test of the freshness of the substance 
is the clearness of the solution. Chlorin is the active 
agent in disinfecting, and when the chlorin is lost, the 
solution will be of a milky color. 

Labarraque’s solution is a combination of soda car- 








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208 


HYGIENE 


bonate and chlorinated lime. It removes stains from 
glass and is often useful in cleansing and disinfecting 
glass appliances and bath-room utensils. 

Floors of bath-rooms or of any room in which infectious 
substances are contained, carried about, or disposed of 
should be given careful attention. Either bichlorid of 
mercury (1 : 1000) or carbolic acid (5 per cent.), applied 
hot, will render them sanitary. Thorough scrubbing with 
a hot solution of lye and water, or one in which soda car¬ 
bonate is freely used, is sufficient for ordinary cleansing. 

Carpets or rugs which have become contaminated with 
infectious discharges in a sick room, may be disinfected 
by wetting with a 5 per cent, solution of formalin and 
the room kept closed for twenty-four hours. If these 
are to be subjected to the action of formaldehyd gas in 
the general disinfection of the room, the infected stains 
should be saturated with formaldehyd before the gas 
for general fumigation is evolved. 

Destruction of Insects and Vermin.—Kerosene is 
valuable as a means of preventing and destroying 
roaches and other forms of insect vermin, notably mos¬ 
quitoes. The pure oil is used by spraying or as an 
emulsion with soap and water. The best means of 
preventing trouble from ants, roaches, and such insects 
is to observe thorough cleanliness around sinks, pantries, 
and such places, and leave nothing about that will 
attract them. Prevention is always easier than cure in 
such matters. 

Sulphur fumigation is recommended by Rosenau 
for the destruction of roaches, bedbugs, mosquitoes, 
flies, fleas, and all kinds of vermin, including rats and 
mice. The fumes must be very strong. The same 
strength and general precautions recommended for 
bacterial disinfection with sulphur should be used. 


PERSONAL HYGIENE 


209 


CHAPTER XXI 
PERSONAL HYGIENE 

Personal hygiene concerns itself more particularly 
with the habits of the individual as regards his care of 
his own body. The subject of how to keep well is one 
which nurses should study much more than they do, 
for the matter is one which they can very largely control. 
A great deal of the minor sickness that occurs among 
nurses is clearly preventable. It is largely due to indis¬ 
cretions in matters of diet or clothing, or to carelessness 
which in others they would quickly condemn. 

Hygiene of the Digestive System.—Only a few general 
suggestions can here be given. The subject will bear 
study throughout the greater part of life, for in the matter 
of digestion and digestive disorders the personal equation 
should be considered in every case. 

1. Masticate food thoroughly. Imperfect chewing of 
food is the cause of a large proportion of digestive dis¬ 
orders. It is a habit or condition that is notoriously 
common in hospitals and among nurses. Food which 
reaches the stomach in a coarse, unmasticated condition 
throws extra burdens on the stomach, as full digestion 
cannot take place until the fibers of food are disintegrated, 
so that every part may come in contact with the digestive 
juices. It means also that the food has not remained 
long enough in the mouth for a sufficient amount of saliva 
to be mingled with it for perfect digestion. Food which 
is forced in this condition into the stomach often acts 
as a mechanical irritant to the delicate mucous membrane, 
causing gastric catarrh. 

2. Avoid eating too frequently. The pernicious habit 
of nibbling at popcorn, candy, cake, bananas, etc., cannot 
be too strongly condemned. Too frequent eating means 
overwork for the stomach; no time is allowed in which 
it may rest. Being composed largely of muscles, it 
becomes weary from constant exercise and soon is unable 

14 


210 


HYGIENE 


to do its work properly. Late suppers usually mean 
disturbed sleep. During sleep there is a slowing of all 
the vital functions and digestion is retarded. In con¬ 
sequence of delay, chemical changes take place in the 
food. Certain acids and gases are developed, which act 
as irritants to the lining of the stomach. Accumulation 
of these gases results in distention of the stomach, pressure 
on other organs, and in time weakening of the stomach 
walls result. Bedtime meals should at least be of light 
and easily digested food. 

3. Avoid taking too much fluid at meal time. Excess 
of fluid dilutes the gastric juice and retards its action. 

4. Avoid taking too much frozen food or iced drink, 
and when used take it slowly. Digestion requires a 
temperature of about 100° F. 

5. Avoid foods that are known to disagree. There are 
comparatively few individuals who can use all foods 
without inconvenience. 

6. Avoid overloading the stomach. Overeating is the 
cause of many disorders. It not only overtaxes the 
digestive organs, but the organs of elimination, especially 
the liver and kidneys, are injured by being forced to deal 
with an overwhelming amount of waste matter. So-called 
“bilious attacks” are frequently induced by overeating, 
too rich food, or too much coffee. A well-known medical 
writer stated a fact tersely when he said “The liver acts 
like a wise horse when overloaded—simply stands still 
until part of its burden is removed.” Another writer, 
speaking of overeating, says, “The surplus fund of 
nutrient material unused is stored up in some form. 
When a certain amount has been thus disposed of, an 
undesirable balance remains against the feeder, and, 
in young people, is mostly rectified by a ‘bilious attack.’” 

7. Endeavor, as far as possible, to have meals well 
balanced, providing for a proper amount of nutritive 
elements and avoiding an excess of any one element. 

8. Avoid the use of too much fat in food. Fat, in 


PERSONAL HYGIENE 


211 


excess, is apt to retard gastric digestion by coating the 
iood so that the juices cannot penetrate. 

9. See that starchy foods are thoroughly cooked. 
Insufficient cooking of foods containing starch is a common 
cause of digestive disorder. 

10. Avoid eating a heavy meal when overtired or 
worried. In either case the secretion of digestive fluids 
is likely to be deficient in quality and quantity for good 
digestion. 

Hygiene of the Mouth and Teeth.— The care of the 
teeth and oral cavity is especially important for nurses 
who are constantly exposed to infection from various 
sources. 

Dental caries is so common that its possible effects on 
the general health are often overlooked. In this condition 
the enamel and dentin of the teeth are dissolved and dis¬ 
integrated by the action of acid-producing bacteria and 
their products. Infection from the teeth is carried in 
food and drink to other parts of the body, and often gives 
rise to a train of disturbances that is serious in its effects 
in the individual concerned. 

The tonsils have been made the subject of extensive 
research in recent years. While their function is still not 
clearly understood, it is believed by many that they serve 
as a filter to some extent, and assist in protecting the body 
against the entrance of harmful bacteria. 

Diseased tonsils are a source of danger to the body 
in various ways. Recent investigations into the causes 
of rheumatism (so-called) and certain forms of heart 
trouble tend to the belief that the infectious agent causing 
the trouble was first deposited in the tonsils, and that the 
general infection followed slowly and insidiously, but 
none the less surely. The injurious effects of diseased 
and enlarged tonsils on the ear and the hearing of the in¬ 
dividual are now fairly well understood. Prevention of 
all these troubles is much easier than cure. 

Hygiene of the Skin. —The health of the skin is 
largely dependent on three things: proper diet, exercise, 


212 


HYGIENE 


and regular bathing. The skin is a most complex organ 
—one of the great safety-valves of the system. When 
an internal organ fails to do its work, the skin often 
attempts to compensate by extra exertion. A daily 
sponge-bath is within reach of most people and is a good 
habit to form. The face and neck, being constantly 
exposed to dust, need more frequent cleansing. The 
feet should have, whenever possible, at least one cleansing 
each day. The axilla, because of the detention of secre¬ 
tions, needs at least a daily washing, while the hands and 
arms will need many. In the study of physiology it was 
shown how the outer layer of skin is always being rubbed 
off by friction. Besides the fluid which exudes from the 
pores in the form of perspiration there is a considerable 
amount of solid matter excreted daily by the skin. 
This, with the dust from the atmosphere, soon forms a 
crust which blocks the pores and interferes with the func¬ 
tions of the skin if not removed. 

Baths for ordinary cleanliness should be suited to 
the season of the year and the inclinations of the indi¬ 
vidual, so far as temperature is concerned. The tonic 
effects of a cold sponge, spray, or plunge bath are well 
known, but these should not be used indiscriminately. 
If time for bathing is limited in the morning, a wet towel 
quickly applied followed by a brisk rub with a dry coarse 
one is a good substitute. In fact it is a good plan when 
in health to follow all cleansing or tonic baths with 
friction of some kind. 

The best time for a bath is just previous to a meal or 
from two to three hours after. During digestion the 
stomach needs an extra supply of blood. If by means 
of a bath the blood is drawn from the stomach to the 
superficial parts of the body, digestion is sure to be 
retarded. 

Hygiene of the Respiratory System. —The natural 
entrance to the air-passages is the nose, which is so con¬ 
structed as to act as a filter to the air, preventing the 
entrance of dust and moistening and warming the air. 


PERSONAL HYGIENE 


213 


Any obstruction to the nasal passages makes mouth 
breathing a necessity. As the mouth offers no obstruc¬ 
tion to the entrance of dust with the air, it follows that 
mouth-breathers are especially prone to diseases carried 
by means of the air, such as influenza, tuberculosis, 
pneumonia, etc. 

Colds in the head are usually due to a combination of 
causes. Those who live in a superheated atmosphere 
and accustom themselves to excessive clothing lower 
their resistive power and are especially liable to catarrhal 
affections of the air-passages. Other causes are prolonged 
exposure to cold or dampness, sudden chilling of the 
body, impure air, and bacterial infection. The habits of 
the individual will determine in large measure his ability 
to resist this affection. A generally clogged-up system 
predisposes to colds, and very slight causes are needed 
to produce an active congestion. Sleeping in unventilated 
rooms is another condition that tends to susceptibility 
in this direction. Those who wilfully shut out fresh air 
and refuse to admit the oxygen that Nature has provided 
must expect to suffer more or less from respiratory 
ailments. The idea that night air is unwholesome is 
erroneous. Certainly in cities the night air is purer, 
freer from dust than during the day. 

Compression of the chest by improper clothing plays its 
part in inducing weakened lungs. The practise of deep 
breathing, especially when in the open air, helps to 
increase chest expansion. Modern physicians are laying 
more and more stress on proper methods of breathing 
as important aids not only in the prevention of tuberculosis 
and other disease of the air-passages, but in maintaining 
general health. The proper management of the body 
when in an overheated condition is a subject of which 
a great many individuals know good general hygienic 
rules which they do not practise. It is not uncommon 
to see an intelligent woman while overheated and in a 
state of active perspiration rush immediately out into 
the cool air. A common example is that of the woman 


214 


HYGIENE 


who has become overheated by washing in a warm room, 
the atmosphere of which is saturated with steam, who 
rushes out dripping with perspiration into a freezing 
atmosphere to hang the clothes on the line. Quite as 
frequently one may see a man who has become over¬ 
heated by extra exertion, throw off his overcoat, take a 
drink of ice-water, sit down in a draught to cool off, or 
go at once to the table and indulge in a full meal while in 
an overheated, exhausted condition. The same man, 
if his horse is perspiring freely, will at once give orders 
that it must not be fed a full meal, must not be allowed 
to drink freely of cold water, must be blanketed until 
dry, or at least must be allowed to cool off gradually. 
The observance of these simple hygienic rules which are 
generally regarded in the care of horses would, if always 
applied to individuals, prevent much discomfort. These 
are homely illustrations of hygienic blunders, but any 
observing nurse must admit that they are true to life. 
If nurses are to become, in deed and in truth, teachers of 
hygiene, instructors of those with whom they come into 
contact in better methods of living, they should them¬ 
selves practise such methods till good hygienic habits 
have become second nature. 


CHAPTER XXII 
PERSONAL HYGIENE ( Continued ) 

Hygiene of the Hands.— The care of the hands is 
one of the most important of all hygienic considerations 
to nurses. Through them she may most easily herself 
become infected or carry infection to others. Any 
break in the surface of the skin is an avenue by which 
disease germs may gain entrance. One of the first 
lessons a nurse should learn and practise till the habit 
becomes deeply rooted is to avoid handling with the 
fingers soiled dressings or materials of any kind saturated 
with a discharge that contains disease-producing germs. 



PERSONAL HYGIENE 


215 


Every nurse should carry with her constantly her own 
thumb forceps, for use, as far as possible, in handling such 
matter. When in attendance on a patient suffering 
from a communicable disease a basin of disinfectant 
solution should be kept in a convenient place for frequent 
immersion of the hands. Under the finger-nails is a 
favorite lurking place for germs, and it hardly needs to 
be stated that the nails should receive careful attention 
in the cleansing. It is a much better practise for a nurse 
to keep her hands in good condition, finger-nails trimmed 
short, and to form the habit of frequent scrubbing with 
soap and water, than to depend on dipping the hands for 
a moment now and then into a disinfectant solution, 
though the latter is necessary at times. Real disinfection 
of the hands is not accomplished by momentary contact 
with a disinfectant solution. 

Careful cleansing of the hands before meals or before 
partaking of food of any kind is a rule that cannot be too 
closely observed. 

Carelessness regarding this point is one of the very 
frequent causes of typhoid fever. The germs are on the 
hands and are conveyed with food into the alimentary 
tract. There is no question also that when a clean wound 
becomes infected, the cause, in probably the majority of 
cases, is due to contact infection resulting from imperfect 
cleansing of the hands. As a matter of general daily 
care, some good hand lotion should be used to keep the 
skin soft and free from cracks or irritation. It is the 
height of folly to use disinfectant solutions on the hands 
till the skin becomes a mass of cracks, each of which 
becomes a channel for the entrance of infectious germs, 
and to perpetrate this piece of folly in the name either 
of hygiene or asepsis. 

The general care of the feet should include, first, 
cleanliness; second, suitably warm stockings; third, 
properly fitting shoes with broad heels; fourth, dryness 
of shoes and stockings. The French heel, placed near 
the middle of the foot, is an anatomic abomination which 


216 


HYGIENE 


makes walking exceedingly difficult and tiresome, besides 
conducing to weakness of the arch of the foot through 
atrophy of the ligaments which hold the foot in position. 

Where there is excessive perspiration of the feet, daily 
cleansing and change of stockings should be observed. 
There are few if any other articles of clothing which affect 
the comfort as much as shoes. No individual can expect 
to bring to her work the maximum of alertness and 
'energy who is suffering from painful feet or badly fitting 
shoes. 

Hygiene of the Eye.—The health of the eye is closely 
connected with the general health. Anything that seri¬ 
ously affects the general health, producing an exhausting 
drain on the system, will affect the strength of the eye, 
in common with other organs. The eye is intimately 
related to the nervous system and defects in it will not 
only affect other organs through the nervous system, 
but the eye will in turn be affected by derangement of 
the nervous system. 

The eye is probably the most overworked and abused 
organ of the body. When the other muscles of the body 
are exhausted, the eye is still forced to keep at work, 
and often under very difficult conditions. If the eyes 
have been carefully guarded from injury from any cause 
during infancy and childhood, the observance of the 
following general hygienic precautions should be sufficient 
to keep them in normal condition: 

1. When reading, writing, or sewing see that there is 
sufficient light. Reading in a dim light or doing any work 
which makes great demands on the eyes is quite sufficient, 
if continued for any considerable time, to cause serious 
eye disturbance. The best position in reading is the 
upright, leaning slightly backward with the head erect, 
and the book nearly on a level with the eyes. With the 
head held erect there is less liability to ocular congestion. 
No type should be used that is not legible at 20 inches 
from the eye. 

2. The light should be on a level with the top of the 


PERSONAL HYGIENE 


217 


head and should, whenever possible, be arranged so as 
to fall from behind over the left shoulder. 

3. Reading when lying down should be avoided, and 
is particularly dangerous during convalescence from 
illness or when physically tired. In reading when lying 
down or in constant looking upward there is a tremendous 
strain on some of the muscles of the eye, which may in 
time result in permanent impairment. 

4. Reading in street or railway cars is better not in¬ 
dulged in. If attempted at all, the eyes should be re¬ 
lieved by frequent rests. 

5. Sewing or embroidery require the most trying ocular 
labor and the best conditions of illumination, and any 
individual who is conscious of eye defects should spend 
as little time as possible in these employments. 

Continual excessive lacrimation or “ watering of the 
eyes” may be due to the constant presence in the atmos¬ 
phere of vapor or dust, such as exists in manufactories 
of flour and various industrial works where there is 
much grinding of metals. It may also be due to excessive 
smoking, to inflammation of the lining of the lid (con¬ 
junctivitis), or to eye strain from excessive use of the 
eyes or working in a dim light. The symptoms of eye 
strain are very numerous. In many cases the difficulty 
is readily corrected by proper glasses, and it is best to 
consult a reliable oculist when, for any reason, the eye 
directs attention to itself because of pain or defective 
vision. If a child is irritable, complains of headache, 
squints, holds his book close to his face, or seems uncom¬ 
fortable at his studies, there is sufficient reason for a 
skilled examination of the eye. 

Sleep. —An important part of Nature's plan for the 
repair of the waste of the tissues of the body that con¬ 
stantly goes on is in provision for sleep. During sleep 
there is a lessening of the activity of the vital machinery 
of the body and the tissues are able to regain their lost 
tone and vigor. In adult life from seven to eight hours 
out of each twenty-four should be spent in sleep, and 


218 


HYGIENE 


during the years of rapid growth in childhood from ten 
to twelve or more hours each day may wisely be spent 
in sleep. Quietness, darkness, a cool room, plenty of 
fresh air, a bed moderately hard, and covering light but 
sufficiently warm, are conditions favorable to sleep. 
Where there is any tendency to wakefulness, mental 
activity should be guarded against, as far as possible, in 
the late afternoon and evening. Tea or coffee should not 
be indulged in for the evening meal. A light meal at 
bedtime is conducive to sleep. By this means there 
is an increase in the blood supply in the organs of digestion 
and a lessening of the supply of blood sent to the brain. 

Rest and recreation are essential to health, but the 
methods used in securing these are often a source of 
exhaustion rather than of recreation. The real meaning 
of recreation is to refresh, to give fresh life to, or to create 
anew. Anything which contributes to the joy of living, 
without detracting from the capacity for work, may be 
termed a recreation. Anything which leaves an individual 
less able to meet the demands of the coming day is a 
doubtful form of recreation to indulge in. In any active 
career and, certainly, in a nurse’s career, the first asset 
is an alert mind in a healthy body, and those who would 
keep at their maximum must learn to regulate wisely 
their habit of sleeping, of recreation and rest, of eating, 
and general living. They must bring as much intelligence 
to bear on maintaining their capacity for work as they 
do on the work itself. The term overwork is very freely 
used as a reason for a physical break-down, but work 
alone rarely causes physical degeneration if the conditions 
under which it is pursued are sanitary and wholesome. 
Worry is probably much more frequently the cause than 
overwork, and very often unwholesome methods of 
recreation, unwise feeding, and too little sleep are con¬ 
cerned in serious physical collapse. 

Clothing.—The question of clothing is one on which 
much might be said. Each of the four materials—cotton, 
wool, silk, and linen—has its advocates as regards under- 


PERSONAL HYGIENE 


219 


clothing. The material used makes little difference to 
health, providing it is clean, sufficiently warm to protect, 
and generally comfortable. Three principal errors in 
clothing should be avoided by women who have any 
regard for the principles of hygiene: 

1. Having the skirts so long that they trail on the 
ground and gather to themselves the filth of the street. 

2. Wearing skirts so heavy that they drag on the pelvic 
organs. 

3. Wearing corsets that constrict and compress the chest 
and abdomen. The two latter errors in clothing are said to 
be responsible for much of the downward displacement of 
the stomach, intestines, kidneys, liver, and pelvic organs 
that is so common among women, and that carries in its 
train a great many disorders. 

A very common blunder is made by women in dis¬ 
carding heavy underclothing and donning thin gauze 
underwear, lace waists, or other thin materials in severely 
cold weather, in order to appear to better advantage. 
In the clothing of children almost any day on the street 
may be noticed a lack of common sense or ignorance of 
the first principles of hygienic dressing. One example 
is that of a child dressed with short socks extending 
but little beyond the shoe tops, legs bare to the knees, 
while the remainder of the body is wrapped in wool and 
furs. Another extreme is often reached by ignorant 
mothers who burden their babies with an excess of heavy 
body and bedclothing, till the little one sinks beneath the 
exhausting burden and the conditions resulting from it. 

Carriage. —Faulty methods in standing or walking 
are responsible for not only an ungainly figure, but for 
some of the derangements of functions of the organs of 
the chest and abdomen. The erect position in sitting, 
standing, and walking, the throwing of the shoulders back 
to give full play to the chest, should be practised till it 
is a habit. 

General Considerations. —All classes of workers 
need mental recreation—not only a change of scene, but 


220 


HYGIENE 


a change from the subject with which the brain is usually 
busy. Any brain that is forced to keep working in a 
single rut not only fails of its full all-round development, 
but is more likely to quickly exhaust its own forces. 
There is, therefore, a physical as well as a moral reason 
why nurses should train themselves to avoid bringing, as 
subjects of conversation, the patients or the incidents con¬ 
nected with their work to the table at mealtime, or out 
with them when they go on the street. 

The sun is one of Nature’s great regenerative forces, 
and a certain amount of exercise in the open air and 
sunshine is necessary if vigorous health is to be maintained. 

Most forms of labor require that certain muscles and 
parts of the body get more exercise than other parts. 
With nurses the muscles called into play in walking 
usually get plenty of exercise, while other parts of the 
body get little. It does not require a stated hour or a 
special class in gymnastic exercise to secure exercise for 
all the muscles of the body. Any nurse who desires can 
take advantage of body-building exercises. Some form 
of recreation involving active exercise in the open air is 
especially desirable when it can be secured. 

“We should seek such vital capacity, such adjustment 
of all the parts, as will best sustain the whole. Many a 
person loses health because there is a defect in one vital 
part when all the rest of the system is in good condition. 
Where we cannot fully repair or bring an individual up 
to a higher standard of health, we can study the type of 
the individual and bring him up to a higher standard of 
comfort and vigor. We can use the resources we have 
to acquire more. All do not begin with the same capital 
of health or even acquire it, but they can at least learn 
what their capacity is, how to preserve and increase it, 
and live accordingly” (Hatfield). 
































NOTES 







































































































































































































































































NOTES 


NOTES 






SECTION IV 

bacteriology 


CHAPTER XXIII 

BACTERIOLOGY 

Historical Notes. —The story of the development of 
bacteriology is the story of devoted, painstaking experi¬ 
ment and research on the part of physicians and other 
scientists, extending over hundreds of years. 

Nursing and Bacteriology.— The development of the 
science and art of modern nursing is so closely allied with 
the history of the developments in bacteriology in the last 
half century that all nurses should become familiar with 
the outstanding features in the progress in bacteriology. 
We are debtors not only to Florence Nightingale and her 
associates who laid the foundations for nurse training, but 
debtors more than we can ever realize to the labors of the 
noted men whose research in the realm of bacteriology has 
revolutionized the practice both of medicine and surgery, 
and exerted a corresponding influence on nursing methods. 

The history of bacteriology carries us back at least into 
the seventeenth century, and many writers claim that 
several centuries previous there were unheeded announce¬ 
ments of the discovery of “invisible creatures” which were 
believed to have caused various diseases. 

Leeuwenhoek .—In the seventeenth century a native of 
Holland, named Leeuwenhoek, succeeded, by means of a 
special lens which he had perfected, in finding what were 
then termed “animalcules” in water, which he declared 
lived and moved and multiplied. It was many years 

221 



222 


BACTERIOLOGY 


later that the connection between these animalcules and 
communicable diseases began to receive serious considera¬ 
tion. Whether these living organisms, which seemed to 
be associated with epidemics of disease, were the result or 
the cause of the disease was for many years a hotly dis¬ 
puted question. 

Plendz , of Vienna, in 1762, after much study and experi¬ 
ment, asserted his belief that each of the communicable 
diseases was caused by a living germ or microbe which 
multiplied in the system, which could be thrown off by the 
sick and which could be carried by the air to others and 
cause them to contract the disease. The scientific world 
of his day did not accept his theories as proven, and little 
progress was made until the second quarter of the nine¬ 
teenth century was well advanced. 

General Conditions .—Meanwhile epidemics of com¬ 
municable diseases were woefully frequent, and whole 
communities were swept with disease as with a devastating 
fire. Hospital gangrene, suppuration, puerperal sepsis, 
and other forms of sepsis, were every-day occurrences in 
hospitals and homes. Inasmuch as nothing definite was 
known or regarded as proven as to the relation of germs to 
surgical conditions, no precautions were taken to prevent 
the infection of wounds. Disinfectants, as such, and ster¬ 
ilization were unknown in hospitals. Surgeons wore the 
same blood-stained broadcloth or wool coat at all their 
operations, and were proud of the blood-stains which 
dated back months or years. Sponges were used com¬ 
monly for the swabbing of wounds of all classes and 
kinds and for different patients, and so infection was car¬ 
ried from one patient to another. Water was used without 
being boiled in surgery, and dressings were packed on 
shelves or in drawers without any outside covering to keep 
the dust from settling on them. 

Medical students went from the dissecting or autopsy 
rooms to assist at births without even the formality of 
washing the hands being observed in many cases. The 


BACTERIOLOGY 


223 


death-rate from puerperal sepsis in hospitals was appalling. 
Meanwhile experiments in different parts of the world were 
being carried on, and scientists of many countries were 
making their contributions to the founding of the science 
of bacteriology. 

Semmelweis, a Hungarian, who was studying in Vienna, 
announced to the world in 1847 that puerperal sepsis was 
due to the entrance of germs into the genital tract intro¬ 
duced by the hands or in other ways. He noticed that 
the midwives had fewer cases of puerperal sepsis than did 
the medical students, and ascribed as one of the chief 
reasons that the medical students went directly from the 
dissecting room to the birth chamber without proper 
cleansing of their hands. In his own practice he began to 
insist on the rigid cleaning of the hands before approaching 
& lying-in woman, and the good results were soon apparent 
in the marked decrease of cases of puerperal sepsis. His 
fellow-scientists, however, remained skeptical, and his 
theories were ridiculed and rejected for many years. He 
died before he saw his theories and methods generally 
accepted. Improvement in obstetric methods, however 
slow in gaining ground, had actually started before he 
died and dated from his experiments. Here and there 
physicians began to adopt his methods and childbirth 
became less perilous. 

Pasteur .—Three names will always stand out with bril¬ 
liant luster wherever the history of bacteriology is known 
—Pasteur, of France, Lister, of England, and Koch, of 
Germany. Louis Pasteur was born in 1822 and died in 
1895. He lived to see the results of his research accepted 
and put in practice throughout the civilized world. His 
experiments in regard to how germs are spread began in 
1862. While he was not the first to prove the existence 
of germs, nor the first to show their power to cause disease, 
his experiments settled a great many of the disputed points 
and laid sound foundations for future work in bacteriology. 
Accepting as true the assertions of his predecessors in 


224 


BACTERIOLOGY 


bacteriologic research that germs are the cause of many 
diseases and may be carried by the air, he demonstrated 
through a series of experiments that “the development of 
putrefaction took place not from the gaseous elements of 
the air but from particles suspended in the air and which 
fell from the air in a vertical direction. He showed that a 
fluid which was sterile when placed in a flask with a long 
neck laid sideways did not undergo putrefaction until the 
neck was allowed to stand upright and open to the air. 
He showed that germs did not develop spontaneously in 
the body as many claimed, but that growth and reproduc¬ 
tion took place from microorganisms which were floating 
in the atmosphere. He claimed, and proved his claims, 
that germs are always in the air, in water, on the hands 
and the body generally, on surgical dressings and instru¬ 
ments, and by a long series of experiments on the develop¬ 
ment of fermentation and putrefaction, particularly in 
regard to the wine and silkworm industry in France, he 
was able to prove his statement to the satisfaction of 
scientists in general. 

Lister, of England, a surgeon who had studied the work 
of Pasteur carefully, was the first to apply the theory that 
if germs are always in the air, on our hands and bodies, 
on dressings, etc., that their entrance into a wound might 
be the cause of suppuration, and that it might be highly 
advantageous to use some antiseptic or germicidal agent 
to kill the germs before they got a chance to enter a wound. 
Accordingly, he proceeded to try the effect of spraying 
with a carbolic acid solution all around the field of opera¬ 
tion. Dressings were saturated with the carbolic acid 
solution. As was the case with Semmelweis, the bene¬ 
ficial results of trying to keep germs from entering a wound 
were immediately apparent in the wounds treated, and 
the era of antiseptic surgery began. After some years of 
experimenting with antiseptics, it was found that by 
subjecting dressings and other articles to steam steriliza¬ 
tion and keeping them protected from the air or from 


BACTERIOLOGY 


225 


handling with unsterile hands as good results or better 
were secured than with the liberal use of antiseptics 
which was so common in the years following Lister’s 
discovery. 

Lister's work was contemporaneous with that of Florence 
Nightingale, and exerted a tremendous influence in pro¬ 
moting the establishing of training-schools, in order to 
provide nurses who knew how to carry out the surgical 
technic which he inaugurated and which was speedily 
adopted all over the world. Lister first published his 
antiseptic theory in 1867. 

Robert Koch , of Germany, the third of the brilliant trio 
whose names are associated with the history of bacteriology 
in the last half century was another who built on the 
foundations established by Pasteur, in regard to germs 
as the cause of disease. He, for the first time, showed that 
it is possible to isolate the organisms in pure culture, to 
cultivate them indefinitely, to reproduce the conditions 
by inoculations of these cultures into susceptible animals, 
and to continue the disease at will by continuous inocula¬ 
tions from an infected to a healthy animal. 

Koch’s circuit or Koch’s law in regard to germ diseases 
is still accepted. Briefly it is as follows: 

1. The germ must always be found where the disease is 
present. 

2. It must be capable of development in proper culture- 
media outside the body. 

3. These cultures must be capable of producing the dis¬ 
ease in a healthy animal. 

4. The same germ must be found in the inoculated 
animal. 

5. It must be further shown that no other form of micro¬ 
organism is capable of producing the disease, and that 
where the original form of bacteria is not obtainable the 
existence of the disease is impossible. Koch, however, 
will always be best remembered by nurses as the dis¬ 
coverer of the tuberculosis germ which paved the way for 
the modern crusade against that disease. 

15 


226 


BACTERIOLOGY 


Once the foundation principles were established, dis¬ 
coveries of different germs followed thick and fast. (See 
pp. 233-237.) In dealing with germ diseases we are no 
longer fighting an unknown enemy in the dark, but dealing 
with an enemy whose habits are well known. We know 
the conditions under which bacteria flourish, how they 
gain entrance to the body, how they are transmitted from 
the sick to the well in most diseases. We know that the 
germs of disease can be cultivated just as surely as can 
roses in the garden, and equally well how they may be 
destroyed. 

Bacteriology is defined as that branch of science which 
has for its object the study of microorganisms or bac¬ 
teria. 

Bacteria is the general term used to denote the large 
group of microorganisms of different classes. Formerly 
known as animalculse, they are also popularly called 
microbes or germs. They are the lowest form of vegetable 
life and are essential to animal and plant life. Bacteria 
reproduce themselves in two ways: by fission and by 
the formation of spores. 

Fission means the division of the germ into various 
segments or pieces, which soon dissolve partnership with 
the parent cell and, in turn, similarly divide and multiply, 
as long as conditions are favorable. 

Spore Formation.—Spores of bacteria correspond to 
the seeds of plants or grains. When a spore or seed is 
about to be developed, changes take place in the germ. 
Irregular points appear and a capsule is formed around 
the spore. Eventually the parent germ disappears, 
leaving the spore free. By this process bacteria enter 
into a state in which they resist deleterious influences, 
such as heat or cold, to a much greater degree than is 
possible in the growing condition. This is also true of 
plants which produce grains, the seeds retaining their 
power to germinate indefinitely, while the life of the plant 
which produced the seed is comparatively short lived 


BACTERIOLOGY 


227 


and quickly destroyed by frost or other adverse con¬ 
ditions. 

The most wonderful thing about bacteria is their 
power of multiplication. Given favorable conditions, 
one microbe will multiply itself by millions in a day! 
Their rate of development is, however, often cut short 
by the toxins or poisons they produce. 

Requirements for Growth. —Bacteria always require 
warmth, suitable soil in which to grow, and suitable food. 
Germs are quite as exacting in their requirements as 
hothouse plants, so far as surroundings are concerned. 
A germ of tuberculosis might be expectorated on the 
floor. It would not multiply on that location, just as a 
kernel of wheat would not germinate under those con¬ 
ditions, because the warmth, moisture, and nourishment 



it needed were lacking. It might, however, retain its 
vitality for some time, and when dry and stirred up in the 
air would be ready to reproduce itself, as soon as it gained 
entrance to a body which presented favorable conditions. 

Classification of Bacteria.-The two great classes 
oi bacteria are the saprophytes and parasites, as mentioned 

1 n t n A I AO fl /~v n i __ 


in the lessons in hygiene. 


Saprophytes are germs which derive their nutrition from 
dead animal or vegetable matter. 

Parasites are germs which live always at the expense 
of some other living creature. Their activity results 
m a tearing down and weakening of the part to which 
they are admitted. 

Decomposition, fermentation, and putrefaction are 

the work of the saprophytes. Through their activities, 



228 


BACTERIOLOGY 


dead animal and vegetable products are changed into car¬ 
bonic acid, water, ammonia, and other elements which go 
to fertilize the earth and serve as nourishment for vege¬ 
table life. 

In the industrial world the saprophytes do an equally 
important work in their action on hemp fibers, leather, 
wines, vinegar, etc. It is said that germs play an exceed¬ 
ingly important part in the growth of tobacco-; different 
germs producing different flavors in the same plant. 
Their activity in producing changes in milk by the 
formation of certain acids is well known. Other forms of 
bacteria produce chemical changes in butter and cheese. 
As all germs require warmth in order to do their work, 
the keeping of these substances in a cool place, at a low 
temperature, prevents the work of the germs which cause 
milk to become sour. 

The work of the fungus germs is clearly shown in the 
autumn when every leaf on the tree has multitudes of 
these low vegetable organisms at work on it, producing 
the variety of coloring which precedes the return of the 
leaf to form a part of the soil on which it falls. The 
activity of the yeast germs is well illustrated in bread 
making. In many respects there is a close analogy 
between their methods of work and those of the disease- 
producing bacteria. Both require warmth, moisture, 
and a suitable soil that will afford material for growth 
and development. A certain time elapses before the 
chemical changes in bread materials become manifest. 
There also comes a time when such changes are produced 
in the substances as render them incapable of being 
further acted upon by the yeasts—a condition analogous 
to that produced in the body by many of the germs of 
infectious fevers. Their activity is self-limited. 

Classification According to Shape.—Bacteria are 
frequently classified according to their shape, outline, 
and structure into three main groups (with their sub¬ 
divisions) : spheres, rods, and spirals. The spheric 
forms, or those which are practically the same diameter 


BACTERIOLOGY 


229 


when viewed from any point, are named cocci or micro¬ 
cocci. (The prefix “micro” means very small, minute, 
infinitesimal, etc.) 

The rod-shaped or oval are termed bacilli, and those 
twisted, spirilla. 

Cultivation Outside the Body.—Bacteria are culti¬ 
vated outside the body by means of culture-media and 
a suitable apparatus. The media 
is the material used for cultivat¬ 
ing the germs. The most com¬ 
mon substances used as media 
are beef-tea or bouillon, to which 
gelatin is sometimes added; po¬ 
tato; milk; and blood-serum. 

The bouillon, with either animal 
or vegetable gelatin, is the sub¬ 
stance most frequently employed. 

A germ incubator or some method 
of providing warmth is neces¬ 
sary. 

Mode of Grouping. — The 

cocci or micrococci are sub¬ 
divided according to their pre¬ 
vailing method of grouping, as 
seen in growing cultures. Those 
growing in masses like clusters 
of grapes are named staphylo¬ 
cocci; those in chains, strepto¬ 
cocci; those in pairs, diplococci; 
those developing in fours, tetrads; 
those dividing into eights, as in 
cubes, sarcinse. 

Bacilli may be subdivided into two main classes: 
spore-forming and non-spore-forming bacilli. 

General Considerations.—The practical things which 
are especially important for nurses to remember about 
bacteria are: 

1. That both good and bad germs are to be found 


. * 

■ "v-: v 
-vg?.;' % 
•C-' ’ *J 

-::A 

* ' 

'':>*• ’ j 


Fig. 94. —Bacillus tu¬ 
berculosis; glycerin agar- 
agar culture, several 
months old (Curtis). 




230 


BACTERIOLOGY 


practically everywhere—in the air, in water, in the upper 
layers of the earth, on the surface of the body, and in 



Fig. 95-—Various forms of microorganisms: 1, Streptococci; 2, staphy¬ 
lococci; 3, diplococci; 4, tetracocci; 5, spirilla; 6, bacilli; 7, bacilli with 
spores (Paul). 


the alimentary tract. They are not found in. the deeper 
tissues of the body. 

2. That for their growth and multiplication it is 



INFECTION AND IMMUNITY 


231 


necessary for them to fall on a suitable soil with suitable 
surrounding conditions. 

3. That a large number of these low forms of life 
called microorganisms, are helpful rather than hurtful 
to the human system. 

4 T hat ^sease-produemg germs are capable of inde¬ 
pendent life without the body. 

5. That for the occurrence of germ diseases two factors 
are necessary the individual must be in a susceptible 
condition and there must be the inciting cause or agent. 

6. That without the entrance of these germs to the 
body the large number of medical and surgical diseases 
commonly classed as infectious could not take place. 


CHAPTER XXIV 

INFECTION AND IMMUNITY 

Infection is the process by which germs produce 
disease. 

The term “contagious” is applied to diseases that are 
acquired by direct contact with one afflicted with the 
disease. 

The terms infectious and contagious are rapidly being 
discarded as inaccurate or at least confusing. Formerly, 
the term infectious was applied to diseases in which the 
germs were either air or water borne, but no such dis¬ 
tinction between contagious and infectious holds good 
to-day.. So-called infectious diseases are found to be 
transmitted by inoculation, and diseases formerly classed 
as contagious are carried by means of air or water. In 
fact, most of such diseases are communicated in a variety 
of ways. 

The term communicable disease is preferable. It sig¬ 
nifies a disease which is capable of being communicated 
from one person to another without attempting to signify 
the mode of communication. 



232 


BACTERIOLOGY 


The term specific, as applied to diseases, simply signifies 
that the disease resulted from a preexistent case of the 
same disease, through the agency of a special or specific 
germ peculiar to that disease, and found in no other disease. 

Entrance to the Body.—Pathogenic or disease-producing 
bacteria enter the body through the alimentary canal, the 
air-passages, the genital system, the mucous membranes, 
wounds, and the skin. In each specific disease the 
contagion multiplies, chiefly in some part of the mucous 
membrane or the skin, each germ having its special 
location, called the seat of the invasion. The infectious 
matter in large measure is cast off in the secretions coming 
from the seat of the disease. Once outside the body, 
the infectious matter may remain dormant in clothing 
or sick-room furnishings for long periods, still retaining 
its power to infect if given suitable conditions. A great 
many of the more common disease germs are promptly 
destroyed by exposure to oxygen and direct sunshine. 

Among the diseases that may be acquired by contact 
are ophthalmia, syphilis, gonorrhea, and tetanus. Ty¬ 
phoid fever is now frequently classed among diseases 
acquired by contact. The nurse’s, hands too often be¬ 
come carriers of infection to herself and others. 

Smallpox, scarlet fever, measles, mumps, chicken-pox, 
whooping-cough, influenza, diphtheria, erysipelas, and 
pneumonia have been classed as air-borne diseases, which 
practically means that the disease is believed to be usually 
communicated by means of floating dust. 

The air-borne theory of many diseases is a matter of 
dispute between sanitary authorities at the present time. 
The results of research have greatly narrowed the list of 
air-borne diseases, and emphasized the importance of 
using all possible precautions to prevent infection by 
contact. It has been proved that when aseptic precau¬ 
tions are observed in dealing with so-called air-borne dis¬ 
eases, the danger of the spread of infection is slight. 

Rules for prevention of infection in use in many hospitals 
are as follows: 


INFECTION AND IMMUNITY 


233 


To Avoid Taking and Carrying Infection. 1 —Keep fingers, 
pencils, pins, labels, and everything out of your mouth. 

Keep and use your own drinking-glass. 

Do not kiss a patient. 

Wash hands often, and always before eating. 

Keep out-of-doors as much as possible, and always sleep 
with window open. 

Do not touch face or head after handling a patient 
until hands are washed. 

Do not allow patient to cough or sneeze in your face. 

Do not allow patient to touch your face. 

Do not eat anything that patient may wish to give you. 

If taking a drink or lunch, be sure and use the nurse’s 
dishes. 

Put on gown or change uniform when going into the 
ward. 

On leaving ward always wash hands. 

Always remember that infectious diseases are taken and 
carried by contact and not by air infection. 

Diseases Carried by Food or Water. —Enteric fever, 
cholera, dysentery, and some forms of diarrhea are com¬ 
monly communicated by food or water. Food which is 
pure and clean may become infected by the hands of the 
nurse who has been handling an infectious case. Tuber¬ 
culosis and a number of other diseases are also known to 
have been carried in this way, milk being considered a 
specially favorable medium. 

Injection Through a Wound. —Septicemia, puerperal 
fever, and erysipelas gain an entrance to the body through 
a wound or surface lesion. The germs may be carried in 
the air and deposited on a wound, but it is believed that 
infection is chiefly acquired through contact with some 
person or material containing the germ. 

Typhoid fever caused by the bacillus typhosis (some¬ 
times called Eberth’s bacillus, in honor of its discoverer), 
is taken into the system usually through the mouth by 
means of water or food. The germs of disease are found 
in the vomited matter, the discharges from the bowels 
1 City Hospital, Providence, R. I. 


234 


BACTERIOLOGY 


and urine, occasionally through the sputum. Flies 
are active agents in its distribution. Where the disease 
has been conveyed by water, the precaution of boiling 
all drinking-water is not sufficient. Green vegetables 
or fruits are sufficient to convey the infection into the 
system if washed in contaminated water. 

Cholera, due to the comma bacillus, and dysentery, 
caused by the bacillus dysenteric, are communicable in 
the same way as typhoid fever, and the same precautions 
against the spread of infection are necessary. 

Diphtheria is caused by the bacillus diphtheric, often 
called the Klebs-Loffler bacillus. The infection may 
enter the system with food, may be communicated from 
mouth to mouth, or indirectly through infected articles, 
or may enter through the respiratory tract. The germs 
of disease are found in discharges from the throat and 
nose. Whooping-cough and membranous croup may be 
communicated in the same manner as diphtheria. 

Influenza.—The bacillus of influenza enters the system 
usually through the respiratory tract. The infectious 
matter is contained in the secretions from the mouth and 
nose. 

Infantile paralysis is classed as a communicable disease. 
It is believed that the infectious matter is contained in the 
secretions from the nose and mouth, though, because of 
the disturbance of stomach and bowels which so frequently 
occurs at the onset, some authorities incline to the belief 
that the infection in such cases started in the alimentary 
tract. Special care is given to the disinfection or destruc¬ 
tion of all articles contaminated with such discharge. 

Scarlet fever, measles, German measles, and chicken- 
pox are believed to be communicated through the secre¬ 
tions from the throat and nose and the desquamating skin. 
Infection may take place by actual contact with an afflicted 
person or through infected articles, such as books, clothing, 
and food, the dust of the room acting as a distributing 
agent. Domestic animals are common factors in spread¬ 
ing these diseases. 

Mumps is a communicable disease, but the exact 


INFECTION AND IMMUNITY 


235 







Fig. 96.—Streptococcus pyogenes 
(X 700). 


Iig. 98.—Bacillus pneumoniae (X 800): Fig. 99—Bacillus typhosus; a 

o, As seen in sputum. Ordinary form (X 1000); b, flagellate 

form (X 1500). 


Fig. 100.—Bacillus influenzae in nasal Fig. 101.—Bacillus diphtherias (X 1000)- 
secretion (X 1000). 


Fig. 103.—Bacillus tuberculosis: a 
( X 1000); b, ramified or branching form. 



Fig. 102.—Micrococcus meningitidis 
cerebrospinalis (X 1000). 






236 


BACTERIOLOGY 


method of communication is not yet accurately deter¬ 
mined. It is deemed advisable to disinfect all discharges 
from the throat and nose. 

Tetanus is always contracted through wounds, the 
infectious matter being eliminated through the pus and 
discharges from wounds. 

Tuberculosis, caused by the bacillus of tuberculosis, 
may invade any organ of the body. When the lungs are 
attacked, the disease is termed consumption or phthisis, 
scrofula, when the lymphatic glands are invaded, and 
lupus, when the disease attacks the skin. The infectious 
matter is eliminated through the secretion, and pus from 
wounds, through the expectoration or discharges from 
the part affected. It may enter the system through the 
respiratory or alimentary tract or through wounds. 
Dried sputum carried in floating dust is largely respon¬ 
sible for its spread. Kissing and the use of tableware 
used by a consumptive patient may also convey the 
infection. 

Malaria is now classed as a communicable disease. 
It is conveyed from the sick to the healthy by means of 
a certain variety of mosquito. 

Pneumonia is caused by the diplococcus pneumoniae. 
This microorganism is said also to cause meningitis, 
pleurisy, ulcerative endocarditis, sore throat, and some 
other diseases of an inflammatory character. The infec¬ 
tion enters the system through the respiratory tract 
and is eliminated through the secretions from the seat 
of the disease, usually through the sputum, or may be 
communicated from mouth to mouth, as in tuberculosis. 

Erysipelas is caused by the streptococcus pyogenes, 
which enters the system through wounds which may be 
so small as to be unnoticed by the naked eye. The 
infectious matter is eliminated in the pus and discharges 
from wounds or the desquamating skin of the part affected. 
It may be acquired by actual contact or conveyed in 
clothing or infected articles. 

Cerebrospinal meningitis is caused by a micrococcus. 
Present theories are that it is not carried in clothing nor 


INFECTION AND IMMUNITY 


237 


directly communicated from the sick to the well, nor is the 
infectious matter found in the excretions so long as there 
is no lesion of the brain or spinal cord. It is deemed best 
to disinfect all the discharges of the body and such articles 
as come in contact with the patient, following with for- 
maldehyd fumigation. 

Hook-worm disease occurs most frequently in tropical 
countries. It is common in the southern part of the 
United States. It is caused by the uncinaria or hook¬ 
worm, which enters the system in several ways. It may 
be taken into the body with food or drink through the 
mouth, but is believed also to enter through wounds in 
the skin. The disease is classed as a parasitic disease. 
The discharges from the bowels contain the infectious 
matter, and preventive measures are directed to the 
proper disposal of the feces. It has been found that per¬ 
sons who go barefooted or who work in damp earth are 
more liable to contract the disease. 

Yellow fever, like malaria, is communicated by means 
of a mosquito. It may be transmitted by direct inocula¬ 
tion of blood from a patient suffering from the disease, 
but is not distributed in the air, clothing, or infected 
articles. Prophylaxis consists in the destruction of the 
insect through which the disease is communicated. 

Bubonic plague is caused by the bacillus pestis, dis¬ 
covered by Yersin in 1894. It may enter the body through 
a wound and result in a local inflammation, which quickly 
spreads to the lymphatic glands. These glands when 
swollen are termed buboes. It may also enter through 
the respiratory or the alimentary tracts, and infection may 
be conveyed by means of the discharges from the wounds, 
the expectoration, or any of the discharges from the body. 
Flies, rats, mice, and insects assist in spreading the disease. 

Smallpox.—The exact cause of smallpox has not yet 
been discovered, but is generally believed to be of bac¬ 
terial origin and that the infective matter enters in most 
cases through the respiratory tract. It may also be 
introduced through the skin. The disease is so readily 
communicated that all discharges from the body should 


238 


BACTERIOLOGY 


be disinfected. The desquamating skin is probably the 
chief factor in spreading the disease, though undoubtedly 
the secretions from the throat and nose contain the 
specific virus. Flies alighting on the skin or clothing of 
the patient may readily convey the infection from one 
home to another. 

Prophylaxis consists in isolation, vaccination, and 
thorough disinfection. Every possible means should be 
used to prevent the desquamating particles of skin and 
dried secretions from the eruption being distributed as 
floating dust. Inunction with antiseptic ointment, 
bathing in weak disinfectant solution, thorough and 
prompt disinfection of all aticles used, and fumigation 
with formaldehyd vapor are the means depended on to 
prevent the spread of the disease. 

Incubation Period.—The period of incubation is the 
time which elapses between exposure to the germ and the 
time when active symptoms of disease are manifested. 
The period varies with different diseases. 

Natural Resistance.—Each human body has within 
itself a certain amount of resistive power, as well as the 
capacity for repair. The various groups of cells forming 
the brain, kidneys, stomach, etc., have a natural recupera¬ 
tive tendency. There are in the body certain kinds of 
cells, among which are the white blood-cells or leukocytes, 
whose function it is to protect the body from disease. 
These cells, to which the general term “phagocytes” has 
been given, constitute the standing army of the body. 
When disease-producing bacteria gain an entrance to 
the body and lodge there, they are attacked by the 
phagocytes. The precise methods of warfare are still 
to some extent a subject on which scientists differ. Prud- 
den says, “ The cells attempt either to swallow and thus 
kill and digest the bacteria, or to so closely surround 
them as to cut off their oxygen and so destroy them.” 
When the body is in full vigor the poisonous germs are 
easily overcome. When the bacteria are of a very 
virulent type they are able to arrest the action of the 


INFECTION AND IMMUNITY 


239 


phagocytes and to multiply and produce their poison in 
the system. 

All human beings do not start out with an equal amount 
of resistive power. Some persons are, by some peculiarity 
of tissue inherited from their ancestors, much less suscep¬ 
tible to all forms of disease than others, while other indi¬ 
viduals exhibit a peculiar resistance to certain infectious 
diseases, all efforts to produce the disease by artificial 
means proving futile. A common example of this latter 
form of natural immunity is found in persons on whom 
successive vaccinations with the smallpox virus produces 
absolutely no effect. 

Opsonins. The term 1 ‘opsonin” is derived from a Latin 
word, meaning “I prepare a feast for” or “to prepare food 
for.” It is defined as follows: “That constituent of the 
blood-serum of a normal animal which renders bacilli or 
blood-cells prone to be absorbed by phagocytes.” (Dor- 
land.) 

To Sir Almoth Wright, of England, is due the discovery 
of opsonins and the development of opsonic treatment, 
which is designed to increase the power of resistance of the 
body to infection and to overcome attacks of bacterial 
diseases by the administration of a suitable vaccine. 

Opsonic Index.—By this term is meant the degree of 
opsonic potency which the blood-serum of an individual 
represents toward a particular germ. This is ascertained 
by a laboratory process. Conditions which lower the 
normal restive powers of the body cause the opsonic index 
to be lowered. 

The Schick test is now much used to determine the 
susceptibility of individuals, especially children, to diph¬ 
theria. If the blood contains antitoxin, nothing happens, 
and the patient is declared to possess natural immunity. 
If the test is positive a prophylactic serum may be ad¬ 
ministered to produce protection against diphtheria. 

Acquired immunity is conferred on an individual by 
one attack of certain specific diseases, notably those 
commonly classed as children’s diseases, such as measles, 
etc. It implies that certain changes have been produced 


240 


BACTERIOLOGY 


in the tissues by the action of the disease germs, so that 
he is protected from subsequent attacks. In some 
diseases protection for life seems to be acquired by one 
attack. In others the attack serves to protect for a 
period of years only. In certain diseases, such as influenza 
and pneumonia, one attack, instead of protecting from 
others, seems to predispose to subsequent attacks. 

Artificial imm unity is that form of immunity which 
is produced by antitoxins. The antitoxic theory is based 
on the idea that as each germ produces its own special 
toxin, so each of these toxins must have an antidote or 
antitoxin, which will neutralize the poisonous effects of 
the germ. The antitoxins for diphtheria and tetanus 
have proved very valuable. Other so-called antitoxins 
have proved failures, but the subject is still being care¬ 
fully investigated. 

It may be assumed that those who maintain themselves 
in the best physical condition are the least susceptible 
to the activities of disease-producing germs when such 
gain access to the body. If we breathe impure air and 
wilfully shut out Nature’s provision for purification; if, 
instead of choosing plain, easily digested, nutritious foods, 
we force on on our systems injurious concoctions; if we 
will not take time to masticate food thoroughly; if we will 
not rest and play enough, or rest and play too much; if 
we persist in “burning the candle at both ends”; if we 
allow worry to take possession of us, we cannot expect to 
resist the strain when attacked by disease. 

Contact Infection.—The theory of contact infection, 
which has been for many years accepted as the chief 
source of danger in surgery, is also gaining ground in deal¬ 
ing with such diseases as measles, whooping-cough, diph¬ 
theria, scarlet fever, and typhoid fever. Experience goes 
more and more to show that the nurse is in large measure 
responsible for infection when it occurs, and her personal 
responsibility for carrying out a systematic preventive 
technic for her own safety as well as for the safety of 
others cannot be too fully impressed on her from the day 
of her entrance to the hospital. 


SURGICAL CLEANLINESS AND DISINFECTION 241 


CHAPTER XXV 

SURGICAL CLEANLINESS AND DISINFECTION 

The cocci or micrococci, the spheric-shaped germs, are 
those most commonly encountered in surgery. They are 
the chief pus-producing germs and are always in the dis¬ 
charges from abscesses, boils, and unhealthy wounds. 
They are also the cause of septicemia and various other 
forms of blood-poisoning. None of these diseases can 
occur without them. 

In describing these particular germs the term “pyo¬ 
genes is used, which means pus producing. 

The staphylococcus pyogenes aureus (“aureus” 
means yellow), or the yellow pus germ, is found not only 
in boils or abscesses, but in many forms of disease which 
attack the skin and mucous membrane. It is practically 
always present in hospital wards. A favorite lurking place 
in the body is underneath the edges of the finger-nails. (An 
authority on bacteriology states that the ordinary clean 
hand contains about a hundred varieties of germs, not 
all of which, however, are harmful.) 

The streptococcus pyogenes is one of the most fre¬ 
quent causes of postoperative peritonitis and cellulitis. 
It is also a common cause of pus. When pus forms in a 
wound, the process is known as suppuration. 

The pneumococcus, the pneumonia germ, not only 
is able to cause that disease, but is also a frequent cause 
of inflammation in wounds. Abscesses of the ear and 
in the pleural cavity and meningitis are in many cases 
due to it. It is commonly present in the dust of the 
street. 

The bacillus of tetanur> is always to be feared in acci¬ 
dental wounds which have become infected with the dust 
of the street, cellars, or stables. 

The bacillus coli communis is normally present in 
the bowel. It is found, as a rule, in appendicitis, and is 
an important factor in producing inflammation of the 
urinary organs and peritonitis. 

16 


242 


bacteriology 


The gonococcus is the cause of gonorrhea. It grows 
readily on the mucous membrane of the eyes, P rod ucmg 
gonorrheal ophthalmia, and is a frequent cause of ovarian 
abscess and inflammation of the genital organs, these 
germs live but a short time outside of the human body. 
Infection by the use of towels containing S° n0 ^ 1 J 1 ^ 
charge or from water-closets does occasionally occur ’ d 
the most frequent mode of infection is by contact w h 
some one having the disease. Infection of the eyes y 
often results from rubbing them with infec * ed da , ’ 

hence the need of extreme caution in nursing this class 

° f The 6 bacillus of tuberculosis is the cause of a large 

nit- of wound, About on.-.o»«h ofJ 

gical cases are said to be tuberculous. Hip-joint d!^ 

Pott’s disease, and various other diseases, mostly 

of bones, joints, or glands, are caused by it. Jhe pu 

producing germs flourish in tissues already attacked by 

the germs of tuberculosis, and mixed infections are very 

C Tt“s°highly important to remember that the pus germs 
are found in abundance on the skin and mucous mem¬ 
branes, particularly in folds and creases of skin,a S mthe 
axilla, hands, and groin. They are also in all the onfices 
of the body and in the secretions, in dust, and on every¬ 
thing exposed to air or dust. 

METHODS OF DESTROYING BACTERIA 
Sterilization implies the complete destruction of the 
vitality of all organisms that may be present in or upon 
the substance to be sterilized. It can be accomplished 
by the proper application of either heat or chemical agents. 
It should be remembered, however, that a thing may have 
been sterilized, but not be sterile. Exposure to the air 
of material that has been sterilized will quickly render 
previous sterilization of no effect in ensuring surgical 

cleanliness. . ... . 

Disinfection implies the destruction of all germs that 


SURGICAL CLEANLINESS AND DISINFECTION 243 

have the power to infect, but not necessarily of all the 
bacteria present. 

Antiseptics are substances which prevent the growth 
of bacteria without, of necessity, destroying them. A 
substance may be an antiseptic without possessing disin- 
ecting properties, but a disinfectant is always an an¬ 
tiseptic. 

Germicides and disinfectants are interchangeable terms. 
Both destroy infectious germs. 

Deodorants are agents which neutralize offensive odors. 
Heat. The most effectual of all methods in the de¬ 
struction of germs is heat. Fire is the greatest of all puri¬ 
fiers, and is generally employed in disposing of infected 
material in the form of soiled dressings from wounds and 
useless dangerous materials. 

Hot air, steam, or boiling water are usually employed 
in the sterilization of mattresses, clothing, and surgical 
dressings. Surgical cleanliness requires the use of both 
chemical germicides and heat, as neither is applicable to 
all substances. 

Boiling is one of the easiest and most effective of all 
methods of sterilization. It has been proved that a degree 
of moist heat much below boiling-point is sufficient to 
destroy a large number of infective agents. Expert bac¬ 
teriologists claim that a temperature of 158° F. will 
destroy the germs of typhoid fever, diphtheria, tubercu¬ 
losis, erysipelas, pneumonia—in short, practically all 
non-spore-forming bacteria within one-half hour, and that 
a temperature of 212° F., or boiling-point, destroys them 
at once. 

Boiling water is made still more effectual in the cleans¬ 
ing of floors, furniture, etc., by the addition of bichlorid 
of mercury or some other germicidal agent. 

For the disinfection of surgical instruments ten minutes’ 
boiling is sufficient. Soda bicarbonate is often added to 
the water in which such instruments are boiled to prevent 
rusting. 

Baking, or dry heat, is not so reliable as moist heat 


244 


bacteriology 


as a disinfectant. It lacks penetrative power and in¬ 
jures most fabrics. In the absence of a sterilizer baking 
may have to be resorted to. A temperature of about 
230° F. in an oven will destroy the germs of most of the 
communicable diseases. In the absence of a high-register¬ 
ing thermometer authorities have stated that baking or 
one hour at a temperature slightly below that which will 
brown or scorch cotton goods will accomplish the disin¬ 
fection of small articles. This method is liable to damage 
cotton, woolen, or linen goods by rendering them brittle. 

Steam Sterilization.—Exposure to live steam for from 
one-half hour to an hour, the length of time depending on 
the amount of steam pressure, is sufficient to destroy all 
but the most virulent germs. Exposure for one hour with 
steam at its ordinary temperature and pressure is relied 
on to destroy both bacteria and spores. When it is possi¬ 
ble to secure a considerable degree of pressure, the time 
required to sterilize usually does not exceed one-half hour. 
Steam at a pressure of 15 pounds to the square inch will 
surely sterilize in twenty minutes. Steam injures silk 
clothing, leather, fur, skins of all kinds, and rubber goods 
of all kinds that are made of impure rubber. In arrang¬ 
ing articles for steam sterilization care should be taken 
not to make bundles large, not to wedge the articles in 
tightly, and to remove the tops of all jars or bottles. 
Otherwise the steam cannot penetrate, and sterilization 
cannot be relied on. 

Intermittent or fractional sterilization consists in expos¬ 
ing the articles to be sterilized to the action of steam for 
three successive days. The theory underlying the prac¬ 
tise is that spores of certain bacilli have been found to 
retain the power to germinate after an exposure of hours 
to the temperature of boiling water. The object of inter¬ 
mittent sterilization is to destroy all bacteria that may 
have developed from spores after the first sterilization. 
This method is frequently necessary in laboratory work, 
but is rarely required in general surgical work. Regarding 
\fhe practise of intermittent sterilization as carried on in 


SURGICAL CLEANLINESS AND DISINFECTION 245 

some hospitals, Dr. Charles Harrington, late of the Harvard 
Medical School, says, 1 “The most resistant pathogenic 
spores are killed by a few minutes , boiling. In the case 
of dressings treated properly with steam under pressure, 
both the bacteria and the spores present are destroyed 
with one exposure, for even very resistant spores cannot 
resist steam under 15 pounds of pressure for ten minutes. 
But supposing they could, what effect would a second 
treatment on the following day have upon them? None 
whatever, for in the absence of moisture and nutrient 
material they could not develop into bacilii, and so long 
as they remained spores they would within reasonable 
limits retain their resistance. So a second exposure would 
be as futile as the first, and a third, fourth, and fifth would 
be equally barren of results.” 

The same authority calls attention to the danger from 
bacteria in the air of the operating-room, as follows: “A 
sterile Petri dish was placed upon the instrument table 
during an operation for hernia. At the close of the opera¬ 
tion the dish was removed and incubated. The result 
demonstrated that upon each square inch of the dish, and 
fnferentially of the table and the instruments thereon, 
and presumably on the field of operation, no less than 120 
organisms, chiefly pus cocci, were deposited from the air 
in the course of an hour.” 

Spore-bearing Bacteria.—Most of the germs which 
cause the common communicable diseases do not produce 
spores, and it is only under exceptional conditions that 
spores need to be considered in disinfection. Spore¬ 
bearing bacteria are encountered in tetanus, anthrax (a 
disease which occasionally attacks tanners, butchers, and 
workers in hides), and malignant edema. The germs of 
cholera* typhoid fever, dysentery, pneumonia, diphtheria, 
erysipelas, influenza, cerebrospinal meningitis, tubercu¬ 
losis, and pus-producing germs do not have spores and 
are readily destroyed by the ordinary methods of disin¬ 
fection, intelligently used. In sterilizing after a case of 
1 Some Studies in Asepsis. 


246 


bacteriology 


tetanus at least twice as long exposure should be allowed 
as under ordinary conditions. 

Some Facts About Asepsis. 1 — Asepsis is the absence ot 
septic matter, or freedom from infection: 

“1. No wound is absolutely free from germs. 

“2. In cases where wounds heal by primary union (very 
quickly) this does not mean that no germ has entered, but 
that so few germs have entered and the severed tissues 
have been so little damaged that the tissues have killed 
or rendered harmless the few germs present in the 

wound. . , 

“3. When pus forms in a wound made through healthy 
skin and into healthy tissues, it is usually due to some of 
the following causes: 

“(a) An enormous number of germs put into the wound 
during the operation. 

“(6) Severe damage to the tissues during the operation 
by manipulations of the operator, or by chemical irritants 
in the form of antiseptics. 

“4. Mechanical cleansing for ten minutes with sterile 
nail-brush, soap, and water removes 99 out of every 100 
germs on the surface of the skin. 

“5. No chemical irritant (commonly known as an anti¬ 
septic) can kill germs in a wound without also killing the 

tissues of the wound. , 

“6. In cases infected before operation, never forget that 
however badly infected the wound may be, it is always 
possible by introducing more germs to make the infection 

worse. . 

“7. In dressing a wound it is essential to take the same 
precautions as during operation. Whenever possible, use 
boiled rubber gloves in dressing wounds or m handling 
dressings soiled with discharge from a cavity, or handle all 
soiled dressings with forceps. 

“In doing dressings without gloves where pus is present, 

the nurse runs the risk of: 

“(a) Of infecting herself. 

i C. Hamilton, Whiteford, M. D. 


SURGICAL CLEANLINESS AND DISINFECTION 247 

“(6) Of carrying infection to the next patient. 

“8. Mechanical cleansing and application of iodin will 
render the skin surface almost free from germs, but germs 
are still found in the deeper parts of the skin. 

“9. The mouth and nose of every adult are full of germs. 
One drop of saliva contains as many germs as a drop of 
sewage. 

10. Never forget that the theory of aseptic surgery is 
simple, but the practical application of the theory is most 
difficult, and can only be successfully carried out by the 
co-operation of every one connected with an operation. 
Any careless person, by neglect of a single elementary pre¬ 
caution, can spoil the result. What is known as the 
“aseptic conscience ,, is essential for obtaining aseptic 
results. The worker who develops an ‘aseptic conscience 7 
avoids breaking rules of asepsis, because he wishes to give 
the patient the best possible chance for an uncomplicated 
recovery. 7 7 

General Considerations Regarding Disinfectants.— 

In selecting a disinfectant solution a number of points 
should be considered: 

1. The kind of germ to be destroyed. 

2. The material in which the infectious matter is incor¬ 
porated. 

3. The amount of matter to be disinfected. 

4. The strength and temperature of the solution. 

5. The effect the disinfectant is likely to have on sur¬ 
rounding substances that will be exposed to it. 

6. The time required for the solution to destroy the 
germ. 

7. The composition of any material associated with 
the matter to be destroyed. 

Some bacteria are much more resistant than others and 
require longer exposure. 

Some disinfectants (bichlorid of mercury, for instance), 
when the chemical substance comes in contact with albu¬ 
minous matter in stools or sputum, coagulates the albumin, 
and at once forms a coating around the infectious matter 


248 


BACTERIOLOGY 


which prevents the solution coming in contact with any 
but surface germs, making it unreliable as a disinfectant 
for that class of matter. 

Some chemicals have been found to quickly destroy 
certain germs, while they seem inert toward others or 
practically so. 

The strength of a solution is always important and also 
the temperature. All chemical disinfectants are more 
powerful if applied hot. A solution with but feeble anti¬ 
septic properties when used cold, has been found to be a 
powerful germicide when applied hot. 

The effect of the chemical on different materials should 
always be considered. For instance, corrosive sublimate 
should not be used on metals, or chlorid of lime to dis¬ 
infect clothing. 

The time the infectious matter is exposed to the solu¬ 
tion is also important. If an infected stool to which a 
disinfectant is applied is at once emptied into the sewer, 
where the disinfectant is diluted with volumes of water 
before it can act, then disinfection of the stool has clearly 
not taken place, even though the nurse may have gone 
through the motions, applied the solution, and appar¬ 
ently carried out the rules. Such disinfectant is wasted 
and the infectious substance is not disinfected. Further, 
if the stool is freely mingled with urine, the urine at once 
dilutes the disinfectant just as the same amount of water 
would dilute it, lessens its strength, and a stronger solu¬ 
tion or a much larger quantity should be applied than if 
no urine was present. In disinfecting urine, enough of 
the chemical should be added so that when applied to the 
urine the whole solution or amount of fluid should be 
equal to a 5 per cent, solution of carbolic acid, a 1: 1000 
solution of bichlorid of mercury, or a 3 to 5 per cent, 
solution of formalin. 

Disinfection of Air.—“If the air of a room is infected, 
the best method of disinfecting it is to open the windows, 
and a few moments’ time will serve to replace it by fresh, 
uninfected air. And in so doing there need be no fear 


SURGICAL CLEANLINESS AND DISINFECTION 249 

of endangering the health of the neighborhood, except 
in case of smallpox. Infected air is soon dissipated by 
the enormous dilution of the atmosphere, and by the action 
of the sunlight, the winds, and the rain, thus rendered 
inert. The actual solid substances that then remain in 
an infected room after flushing out its atmospheric con¬ 
tents are the walls, the ceiling and floor, the beds and 
bedding, furniture, etc.” (Gould.) 

Sterilization of air is accomplished, or practically so, 
in some of the large operating-rooms by a filtering process. 
The air is pumped in from outside, washed by passing it 
through water, filtered through successive screens of cotton 
warmed by steam, and carried into the operating-room 
through a special air-shaft. 

Disinfection of Rooms and Contents.—As a general 
rule, gaseous disinfectants are employed for disinfecting 
the room and general contents. For this purpose formal- 
dehyd is the gas most frequently used. (For general 
rules for using gaseous disinfectants, see chapter on Anti¬ 
septics and Disinfectants.) It should always be remem¬ 
bered that no gaseous disinfectant can be depended on 
for more than surface disinfection. The time of exposure 
needed and the strength of the gas have been actually 
determined, so that a nurse need not depend on guess 
work regarding the quantity that should be used to thor¬ 
oughly disinfect. As it is practically impossible to make 
an ordinary room airtight, and there is always more or 
less waste, an excess of gas over the prescribed amount 
is desirable. As none of the fumigating agents possess 
the power to penetrate closed doors or beneath surfaces, 
all possible surfaces should be exposed by opening drawers, 
closet doors, and hanging clothing and bedding on lines 
across the room. Because of the slowness with which 
the gas is generated, formaldehyd lamps, candles, pastils, 
etc., are considered unreliable as disinfectants. 

Natural Disinfection.—Ordinary cleanliness, dryness, 
and sunshine are important aids in the work of disinfec¬ 
tion, as well as in the prevention of disease. Not half 


250 


BACTERIOLOGY 


enough value is placed on sunshine as a destroyer of germ 
life. Expert bacteriologists have found that few of the 
pathogenic bacteria can live many hours exposed to the 
direct effect of the rays of the sun. Dryness is destruc¬ 
tive to many disease germs, and dryness and sunshine 
combined are said by expert disinfectors to be almost as 
effectual as the disinfecting processes commonly used in 
the disinfection of houses. 

The control of communicable diseases is fully discussed 
in pamphlets which may be secured free by addressing 
the United States Public Health Service, Washington, 
D. C. * 

In all cases the least that should be done is to see that 
all furniture and equipment that has been in intimate 
contact with the patient receives as thorough cleaning as 
is possible to give it. In cases of tuberculosis or leprosy 
renovating by repainting all surfaces that can be so 
treated is recommended, following the free use of soap and 
water and disinfectants. 










NOTES 

































































































































































































































NOTES 


NOTES 


NOTES 


SECTION V 

therapeutics and materia medica 


CHAPTER XXVI 

REMEDIAL AGENTS 

The term therapeutics was originally defined as that 
branch of science which deals with the application of 
drugs in the treatment of disease. Therapeutics, in the 
modern conception of the term, is defined as “that part 
of medical science which treats of the discovery and appli¬ 
cation of remedies for diseases.” A still further con¬ 
ception of the province of therapeutics is embodied in 
the statement that: “The science of therapeutics in¬ 
cludes the use of any method or agency for the ameliora¬ 
tion, cure, or even the prevention of disease.” Before 
beginning the study of therapeutics or drugs it is well to 
have at least a slight understanding of the causes which 
make remedies a necessity. 

Disease is a derangement of the structures or functions 
of the body. The causes of disease are exceedingly numer¬ 
ous, but may be roughly divided into the following classes: 

1. Abnormal condition of the external surroundings 
of the human body, such as the action of heat, cold, 
light, electricity, etc. 

2. Abnormal use of the organs of the body. This 
would include excessive or deficient exercise of any part, 
insufficient mastication of food, etc. 

3. Accidents or mechanical violence. 

4. Pathogenic bacteria and parasites. 

A large proportion of the diseases of modern life are 
traceable to the latter cause. 


251 



252 therapeutics and materia medica 

While a nurse is not called on to institute or outline 
treatment for disease, it is well for her to understand that 
in making choice of remedies it is considered desirable 
always to use those which will accomplish the result desired 
with the least tax on the vital powers. It is common to 
speak of the action of a medicine or remedy, but in reality 
the agent is passive. The results are produced by the 
action of the living tissue upon it. The remedial property 
of the agent used in each case is an expression of the 
manner in which the system receives it, not the action 
of the remedy itself. 

Self Repair.—The human body is endowed with the 
power to repair itself. A constant death of tissue goes on 
from birth to death. Cells of skin and of all the tissues 
of the body are dying and new tissue is being formed 
incessantly. Nature always tends toward repair and self- 
preservation, and if external conditions are properly ad¬ 
justed, will often effect a cure without the application of 
any of the so-called remedial agents. The oft-quoted re¬ 
mark of a famous French surgeon, “I dress wounds, but 
God heals them,” is true. The utmost that man can do 
is to study Nature, assist her efforts, and endeavor to work 
in harmony with her. A common example of Nature s 
methods is seen when a splinter or thorn is forced into 
the deeper tissues of the hand. The individual may be 
unconscious of its presence, but it is recognized at once 
as a foreign body by the natural protectors of the body. 
The white blood-corpuscles rush to the scene to force it 
out. A series of changes take place in the tissue, which 
constitute the local manifestation of the attempt to eject 
the intruder and repair the damage. Nature’s methods, 
however, are not always intelligent, and in the intense 
efforts put forth toward self-preservation, harm is often 
done. Stimulation of natural effort is often needed, and 
probably, quite as frequently, it is necessary to check or 
modify Nature’s efforts. While, as previously stated, 
it is not the province of the nurse to treat disease except 
as ordered by a physician, yet, if a nurse is to be an intelli¬ 
gent assistant to the physician, she should have a general 


REMEDIAL AGENTS 


253 

knowledge of the common principles of treatment. She 
should know what he is trying to do and to a certain ex¬ 
tent why he does it. It is also recognized that there are 
so-called. nursing treatments which a nurse should be 
able to give without having to be told every detail, and 
the principles underlying the so-called nursing treatments 
do not differ materially from the underlying principles 
of the treatment of disease in general. 

The following general principles of treatment might 
properly be taught to people in general, since most people 
are obliged to do something toward the treatment of 
human ills at some time in their lives. 

General Principles of Treatment.— 1 . Remove the 
cause of the disorder or derangement if possible. For 
instance, if the cause of a headache is bad air, the sensible 
thing would be to supply pure air, rather than dose with 
headache powders. If the cause of diarrhea is unwhole¬ 
some food, the sensible thing would be to get the irritating 
substance out of the system as quickly as possible, and 
then supply wholesome food. 

2. Secure rest as far as possible for the part affected. 
A large number of cases of disease will be corrected spon¬ 
taneously, without assistance, if rest can be secured for 
the injured or affected part. This is especially true of 
diseases of a surgical nature. 

3. Keep the patient and surroundings clean. To keep 
the patient at rest; to give him clean air to breathe, clean 
suitable food and drink, with clean clothing, a clean bed 
in a clean room, is to provide the most favorable condi¬ 
tions possible for Nature to carry on her restorative work. 

4. As far as possible, use natural remedies, or those 
which are essential to maintaining life and health. This 
would include the use of water, fresh air, light, heat, proper 
diet, and wholesome mental influences. To a certain ex¬ 
tent, a nurse will be expected to use all these natural 
remedies as a part of nursing treatment. In other words, 
if the proper adjustment of these various conditions 
will effect a cure, drugs are rarely used by intelligent 
people. 


254 THERAPEUTICS AND MATERIA MEDICA 

5 Refrain from interfering with Nature unless a remedy 
is clearly demanded. A great many diseases are caused 
by well-meant interference with Nature’s work. The con¬ 
stant drugging that goes on in some homes is a fruitful 
cause of disease. The abuse of the vaginal douche, which, 
when properly used, is a useful remedial agent, is another 
common illustration of this point. A vigorous letting 
alone is sometimes the best of all remedies. 

Diseases are commonly classed as functional or organic. 

In functional disease the organ may be unable to do 
its work properly though its tissues are apparently in 
normal condition. A great many functional diseases are 
treated successfully by bringing certain influences to bear 
on the mind or nervous system. 

In organic disease there is a change in the tissue or 

structure of the organ. , , 

There are but very few diseases for which there has 
been discovered a sure, so-called “specific’ remedy, and 
the exact manner in which an individual will respond to 
the use of a remedy cannot always be foreseen. Drugs 
which prove immediately successful with one patient, may 
fail in the next similar case, and the reason for success 
or failure is not always easy to see. Each individual is 
a study by himself, and nurses should learn to nurse the 
patient, not the disease; to observe intelligently and report 
accurately anything that is likely to have a bearing on 
the case. Many of the functions of human organs are but 
imperfectly understood. The work performed by the 
spleen is still a source of perplexity. The mysteries of 
the liver have never been fully unfolded. The processes 
of digestion and nutrition are exceedingly intricate and 
complex, and afford still a wide field for scientific investi¬ 
gation. Even the causes of the simple act of vomiting 
are but little understood in many cases. 

Sources of Remedies— In the selection of remedies, 
choice may be made from the animal, vegetable, or mineral 
kingdom. A comparatively small number of drugs are 
furnished by the animal kingdom, but these form an ex¬ 
ceedingly important group. Such remedies as antitoxin 


REMEDIAL AGENTS 


255 


and vaccine are secured from living animals. Pepsin, 
pancreatin, and various other drugs are obtained from 
certain organs of animals after death. 

The vegetable world furnishes a great variety of drugs. 
Flowers, leaves, stems, fruit, and roots are all utilized, 
and all countries of the world have made valuable con¬ 
tributions from their products for the cure or alleviation 
of disease. 

Regarding the action of vegetable drugs, much misun¬ 
derstanding exists among the laity. One of the favorite 
boasts of the proprietors of patent medicine establishments 
is that their drugs are perfectly harmless, prepared entirely 
from vegetables, and free from mineral poisons. It is 
well known that some of the most strongly poisonous 
drugs are made from plants. No fact concerning drugs 
needs more frequent emphasis than that practically all 
drugs are poisonous, and all are capable of doing much 
harm unless intelligently used. 

The mineral kingdom has made many important con¬ 
tributions to the list of drugs in common use. Common 
examples are lime, iron, chalk, lead, soda, salt, potash, 
mercury, silver, with their numerous combinations and 
preparations. 

Prophylactic remedies are those which have for their 
object the prevention of disease. These would include 
the proper regulation of all the varied factors that have 
to do with the general health—sanitary conditions of 
homes and surroundings, as regards cleanliness of dwellings 
and general conditions, water, purity of air and food, occu¬ 
pation, habits, exercise, clothing, etc. It would include 
the proper management of baths of various kinds, dieting, 
gymnastics or physical culture; in short, anything that 
has to do with hygiene, general or personal. 

Imponderable remedies are remedies which cannot 
be weighed. They include the invisible forces, such as 
heat, cold, electricity, magnetism, light, etc. All these 
exert a powerful influence over the vital functions of the 
body, and are much in use both as preventive and cura¬ 
tive agents. 


256 THERAPEUTICS AND MATERIA MEDICA 

Mechanical Remedies—In this list are included sur¬ 
gical procedures, massage, etc. Surgery, from “chirur- 
gery” (handiwork), means that part of the medical art 
which deals with the external parts of the body, and w 7 ith 
such ailments as can be seen or touched and helped by 
handiwork, removed by knife or other instruments, soothed 
by fomentations, or supported by splints or bandages. 

Medicinal remedies include all drugs used for the relief, 
cure, or prevention of disease. 

Materia medica is that branch of medical science which 
devotes itself to the study of drugs—their botany, chemis¬ 
try, derivatives, and their action on the human body. 

Miscellaneous Remedies.—Besides these classes of 
remedies, there are a great many others which have been 
found to exert a certain influence in preventing or curing 
disease. That the state of mind has a powerful influence 
over the body is admitted by all who have given thought 
or study to the subject. In recent years a much greater 
emphasis has been placed on the mysterious powers ex¬ 
erted by the mind, and many forms of disease are treated 
by suggestion or mental influence, in combination with, 
and often without, other remedial measures. The cures 
wrought by this means are mainly or entirely of functional 
diseases, or diseases in which the functions of the organ, 
and not the tissues of which it is composed, are impaired. 
To this method of treatment the term “ psychotherapy ” 
is given. 

Occupation of a suitable kind is employed as a remedial 
measure in many forms of nervous and mental troubles. 
So valuable is it considered in its effects ‘on mental and 
nervous diseases that few institutions devoted to the care 
of these classes of cases would be willing to dispense with 
it. The kind of occupation prescribed is a matter of study 
with each individual, but it is considered as a prescription, 
to be carefully and regularly administered, just as are 
medicines. 

Music, suitable reading, and games are also used as 
remedial agents in certain cases. Gymnastic exercise is 
used both for preventive and curative effects. 


REMEDIAL AGENTS 


257 


The rest cure, which includes rest for the body and 
mind as far as it is possible to secure it, combined with 
other remedial measures, is another common form of 
treatment. 

Hydrotherapy is that branch of therapeutics which 
treats of the use of water as a remedial agent. Its impor¬ 
tance is becoming recognized more each year, and a knowl¬ 
edge of the best methods for using this simple, easily ob¬ 
tainable remedy, so that the best results may be secured, 
is considered essential to the modern nurse. 

Organotherapy, sometimes termed “hormone-therapy,” 
consists in the use of animal extracts for the cure or 
relief of various disorders. This comparatively new form 
of treatment is based on the belief that “in certain animal 
organs there are substances which have a stimulating or 
a regulating influence on the corresponding organs in man 
when properly administered.” (See page 125.) 

Pharmacology is the science that treats of drugs—their 
sources, botany, chemistry, preparation, poisonous effects, 
etc. 

Pharmacy is the art which analyzes and identifies drugs 
and provides suitable forms of administration. 

Toxicology is devoted to the poisonous effects of drugs, 
together with their proper antidotes, as well as other means 
of combating or antagonizing the effects of poisons in 
the body. 

Chemistry is that branch of science which treats of the 
composition of substances and the changes which they 
undergo. 

A pharmacopeia is an official list or authorized publica¬ 
tion of standard drugs. In America such a list is pre¬ 
pared and revised at definite intervals by representatives 
of the medical and pharmaceutical professions. 

Official drugs are those recognized by the pharmaco¬ 
peia. They are guaranteed to be of a uniform strength. 

Dispensatories are commentaries on the pharmaco¬ 
peia. They are not official publications. Their list of 
drugs contain both official and unofficial drugs. 

General Considerations.— It will be seen that the 

17 


258 


THERAPEUTICS AND MATERIA MEDICA 


giving of drugs is but a small part of medical treatment. 
Many ill people are conducted successfully through an 
illness without resort to medicines, for instance, many 
obstetric cases, minor surgical cases, and mild fevers. 
The tendency is to depend less on medicines and to put 
more emphasis on preventive measures and general in¬ 
struction as to daily life and habits, but the giving of 
medicines is still an important part of a nurse’s duties. 

Practically, all text-books and most teachers have 
stated in substance that “ a well-trained nurse never diag¬ 
noses and never prescribes.” It is emphasized until every 
nurse in a hospital soon learns that her business is to 
administer remedies, not to prescribe them. Most physi¬ 
cians and teachers make emergencies an exception to 
this rule. Yet, under the social conditions of the age 
in which we live, it is not considered either desirable or 
necessary to have a doctor’s order for every dose of 
medicine that is taken in every home or by every indi¬ 
vidual. Each household has its family remedies which 
are used as occasion arises, without medical orders. What 
should be the nurse’s attitude toward such remedies? 
Is she at liberty to prescribe them? If so, what is the 
limit of her authority? 

Suppose she is nursing in a family in which a child has 
croup. Is she to say when appealed to, Send for the 
doctor, I don’t know what is the matter, and, being a 
nurse, I am not allowed to do anything to relieve the 
trouble without a doctor’s order”? Is she never to pre¬ 
scribe peppermint when a baby has the colic? Is she 
never to mention that a headache may be due to consti¬ 
pation, and prescribe a cathartic or an enema? In minor 
ailments very frequently no doctor is called. For instance, 
in colds, diarrhea, chicken-pox, mumps, etc. When she 
is appealed to in such cases, is she at liberty to prescribe? 
If so, where should she stop? 

It is hardly possible to settle all such cases by arbitrary 
rules, but one general rule may be given, that, while nega¬ 
tive, will cover a great many such conditions: 

Give no drugs without a physician’s order while there 


WEIGHTS, MEASURES, MEDICINAL PREPARATIONS '259 

is a physician attending the case and available for con¬ 
sultation. 

Even this rule may have exceptions, as frequently the 
physician makes very few visits, as in chronic cases or 
protracted convalescence. A simple cathartic may have 
to be given or, possibly, some other simple remedy for the 
relief of pain. Very often such needs can be anticipated 
and provisional orders received from the physician. He 
can usually be reached by telephone. 

Another rule should be to report to the physician as soon 
as possible deviations from orders, or drugs given without 
definite orders during his absence, with the reasons for 
giving them. 

A third rule should be always to try simple natural 
remedies, such as heat, water, hot or cold, etc., before 
resorting to drugs of any kind. 

After all possible rules have been made to meet such 
conditions, the decisioh as to when exceptions may be 
made as to nurses prescribing remedies must largely be 
left to the nurse’s own good sense and judgment. To 
exceed one’s authority is certain to call forth the disap¬ 
proval of the physician in charge, to result disastrously 
for the nurse herself, and to reflect discreditably on nurses 
in general. It is a safe plan never to assume responsibility 
that properly belongs to the physician if it can be well 
avoided. 


CHAPTER XXVII 


WEIGHTS AND MEASURES AND MEDICINAL PREPA* 
RATIONS 


Apothecaries ’ Weight 


20 grains 
3 scruples 
8 drams 
12 ounces 


1 scruple 
1 dram 

1 ounce or 480 grains 
1 pound 



260 THERAPEUTICS AND MATERIA MEDICA 


Apothecaries ’ Measure 


60 minims 
8 fluidrams 
16 fluidounces 
2 pints 
4 quarts 


1 fluidram 
1 fluidounce 
1 pint 
1 quart 
1 gallon 


Approximate Measures 


One teaspoonful 
One dessertspoonful 
One tablespoonful 
One wineglassful 
One teacupful 
One tumblerful 



fluidram 

fluidrams 


u 


ounces 



The minim is the standardized drop, but drops and 
minims vary greatly in amount. The minim is measured, 
and is the same whatever the fluid may be. 

The drop varies according to the consistency of the fluid 
and the surface of the vessel from which it is dropped. 
For example, a drop of molasses is larger than a drop of 
water, and a drop of water dropped from the edge of a 
pint measure would be larger than a drop from an eye¬ 
dropper. Each nurse should provide herself with a gradu¬ 
ated minim glass, measuring 2 drams or 120 minims, and 
a graduate measuring glass holding at least 1 ounce. 

In the absence of a minim glass, the following rule may 
be useful to remember: 

Water or aqueous fluids-1 drop = 1 mmim. 

Alcoholic fluids.2 drops = 1 minim. 

Chloroform or ether.4 drops = 1 minim. 

The metric or decimal system of weights and measures 

is used to some extent, and is the official system of the 
United States Government. It is being very slowly 
adopted by the medical profession. 

It has three standard units—the meter, the liter, and 




WEIGHTS, MEASURES, MEDICINAL PREPARATIONS 261 


the gram. Additional tables (including the metric sys¬ 
tem) will be found in the Appendix. In reading orders 
and prescriptions, it may be helpful sometimes to remem¬ 
ber that a gram is the approximate equivalent to 15 
grains, a cubic centimeter (milliter) is the approximate 
equivalent to 15 minims or { fluidram, 4 cubic centimeters 
is the approximate equivalent to 1 fluidram, a liter is 
1000 cubic centimeters and approximately equal to 1 
quart. The common abbreviation for gram is gm., for 
cubic centimeter, cc. In the metric system the common 
or Arabic numerals are used, and are placed before the 
terms designating the quantity, as 50 cc._(2.50 g m .). 

Medicinal Preparations.—Practically all drugs, 
whether in the form of leaves, bark, roots, seeds, min¬ 
erals, etc., must go through a process of preparation 
before they are fit for administration. 

Alkaloids are active principles from vegetable drugs. 
They are mostly poisonous or very energetic in their 
action. Alkaloids end in in or ine, as, morphm or 
morphine. 

u Alkalies are chemical substances whose distinguishing 
peculiarities are solubility in alcohol and water, uniting 
with fats and oils to form soap, neutralizing and forming 
salts with acids, turning to brown several vegetable yel¬ 
lows, and changing reddened litmus to blue ” (Webster). 
Common examples are soda, lime, potash, ammonia, and 
lithia. Alkalies are frequently classed as antacids. 

Salts is a general term applied to chemical compounds. 
Mineral salts, which are used as aperients or cathartics, 
are distinguished by various prefixes, as Epsom, Rochelle, 
etc. 

Acids are sour substances. Chemically an “ acid is one 
of a class of compounds generally but not always distin¬ 
guished by their sour taste, solubility in water, and red¬ 
dening of vegetable blues or violet colors.” Acids have 
the power to destroy or neutralize alkalies. Familiar 
examples of vegetable acids are vinegar and tartaric and 
citric acids. 


262 THERAPEUTICS AND MATERIA MEDlCA 

Capsules are hollow cones of gelatin, used chiefly to 
cover disagreeable substances. 

Cataplasma are poultice substances mixed into paste 
for external application. 

Cerates are preparations made with wax and oil for 
external application. They differ from ointments in that 
they do not melt at the heat of the body. 

Chartce or Papers. —The term is used in speaking of 
wrappers for powders, and also in referring to medicated 
papers prepared for external application. 

Decoctions are solutions of vegetable substances made 
by boiling in water and straining. They soon decom¬ 
pose and require to be freshly made every forty-eight 
hours. 

Elixirs are sweetened spiced preparations made with 
alcohol and water. They are a favorite method of dis¬ 
guising disagreeable drugs. 

Extracts are solid or semisolid preparations which con¬ 
tain the condensed active principle of a drug. 

Fluidextracts are alcoholic solutions of vegetable drugs 
of a definite strength. 

Glycerites are solutions of medicinal substances com¬ 
bined with glycerin. 

Infusions are solutions of vegetable substances made 
with either hot or cold water, without boiling. 

Emulsions are mixtures of oil and water, made by rub¬ 
bing with gum arabic, yelk of egg, or other mucilaginous 
substances. 

Mixtures are watery preparations of an insoluble sub¬ 
stance held in suspension. 

Liniments are preparations of an oily or soapy nature 
made for external application with friction. 

Tinctures are alcoholic solutions of vegetable drugs of 
various strengths. They resemble fluidextracts, but are 
less powerful. 

Tablets are solid preparations in which sugar-of-milk 
or some similar substance is used as a medium for giving 
bulk and shape to otherwise very small doses of drugs. 


WEIGHTS, MEASURES, MEDICINAL PREPARATIONS 263 

Pills are round, solid substances used for holding medi¬ 
cines designed for slow action. They are soluble in the 
warm fluids of the mouth and stomach. Soft mass pills 
in putty-like masses, which may be easily flattened between 
finger and thumb, are now obtainable in many standard 
combinations. These dissolve more readily in the diges¬ 
tive tract. 

Triturates are mixtures of drugs and sugar-of-milk in 
the proportion of 10 per cent, of the medicinal substance. 
Triturate, as a verb, means to pulverize thoroughly or 
reduce to a very fine powder. 

Syrups are sweetened watery preparations of drugs. 

Mucilages are preparations of gummy substances dis¬ 
solved in water. 

Wines are preparations resembling tinctures, but made 
with wines instead of alcohol. 

Suppositories are cone-shaped bodies, made with a base 
of cocoa butter, for insertion into the rectum, vagina, or 
urethra. 

Spirits are solutions of volatile substances in alcohol. 

A saturated solution is one which contains all of a sub¬ 
stance that can be dissolved. A saturated solution can¬ 
not be made stronger. Any excess of the drug is deposited 
as sediment. The strength of saturated solutions of dif¬ 
ferent drugs varies. 

ABBREVIATIONS AND SYMBOLS 

aa {ana), of eacn. 

Ad. {ad), to or up to. 

Ad. lib. {ad libitum), as you please. 

Alt. hor. {altemis horis), every other hour. 

Alt. noc. {alternis nocte), every other night. 

A. c. {ante cibum), before food. 

Aq. dest. {aqua destillata), distilled water. 

Aq. pur. {aqua pur a), pure water. 

B. i. d. {bis in die), twice a day. 

C. , Centigrade. 


264 


THERAPEUTICS AND MATERIA MEDICA 


C. (cum), with. 

C. ( congius), a gallon. 

Cap. (capiat), let him take. 

Chart, (charta), paper. 

Cib. (cibus), food. 

Comp, (compositus), a compound. 

Conf. (confectio), a confection. 

Cc., cubic centimeter. 

Cm., centimeter. 

Collim. (collunarium), nasal douche. 

Collyr. (collyrium), an eye-wash. 

Decub. (decubitus), lying down. 

Dol. urg. (dolor unguente), when the pain is severe. 
Det. (detur), let it be given. 

Dil. (dilutus), dilute. 

D. in p. aeq. (divide in partes (Equates), divide into equal 
parts. 

Dr. (drachma), a dram. 

Emp. (emplastrum), a plaster. 

Et, and. 

En. (enema), a clyster or enema. 

Ex aq. (ex aqua), in water. 

F. (fac), make. 

F., Fahrenheit. 

FI. (fluidus), fluid. 

Ft. (fiat), let there be made. 

Garg. (gargarisma), a gargle. 

Gr. (granum or grana), grain or grains. 

Gtt. (gutta), drop. 

H. (hora), an hour. 

Haust. (haustus), a draught. 

Inf. (infusium), an infusion. 

Inj. (injectio), an injection. 

Lb. (libra), a pound. 

Lin. (linimentum), a liniment. 

Liq., liquor. 

Lot. (lotio), a lotion. 

M. (misces), mix. 


WEIGHTS, MEASURES, MEDICINAL PREPARATIONS 265 

Min. (minimum), minim. 

Man. (mane), in the morning. 

Mist, (mistura), a mixture. 

Noct. (node), at night. 

No. (numero), a number. 

O. (octarius), a pint. 

01. (oleum), oil. 

P. c. (post cibum), after food. 

Pil. (pilula), a pill. 

P. r. n. (pro re nata), as occasion arises. 

Per, through or by. 

Pulv. (pulvis), a powder. 

Q. (quaque), each or every. 

Q. s. (quantum sufficit), as much as is sufticient. 

R. (recipe), take. 

Rad. (radix), root. 

Sig. (signetur), let it be directed. 

Sem. (semen), seed. 

S. or ss. (semis), one-half. 

Sine, without. 

Stat. (statim), immediately. 

S. v. g. (spiritus vini gallici), brandy. 

S. f. (spiritus frumenti), whisky. 

S. v. r. (spiritus vini rectificatus), alcohol. 

Syr. (syrupus), syrup. 

T. i. d. (ter in die), three times a day. 

Tinct. or Tr. (tinctura), tincture. 

Troch. (trochisci), lozenges. 

Ung. (unguentum), ointment. 

Z (drachma), a dram. 

3 (uncia), an ounce. 

B (scrupulum), a scruple. 

In prescriptions, numbers are expressed by Roman 
numerals and follow the symbols to which they relate, 
as: Z], 3iiss, 3iij, gr. ij, gr. iv, gtt. x, TUv. 

Specimen Prescriptions. —For obvious reasons prescrip¬ 
tions are written in Latin: 


266 


THERAPEUTICS AND MATERIA MEDICA 


ty. Magnesii sulphatis. 

Tinct. nucis vom.. 

Aq. menth. pip.. s. ad 

Ft. M. 

Sig. —3 j, 4 hrs. 


5i 

5J. 

3vj. 


Translated into English this would read: 

Take 1 ounce of sulphate of magnesia; 1 dram of tincture 
of nux vomica; sufficient peppermint-water to make 6 
ounces. Let there be made a mixture. Let it be directed. 
One teaspoonful every four hours. 


R. Quininse sulphatis. g r - xy 11 ! 

Pulv. digitalis. g 1- * YJ 

Pulv. opii. g 1 *- U J* 

M. ft. pil. No. xii. 

^ f _ *11 x : j 


Take of quinine sulphate, 18 grains; pulverized digi¬ 
talis, 6 grains; pulverized, opium, 3 grains. Mix. Let 
there be made 12 pills. Let it be directed: One pul 
thrice daily. 


CHAPTER XXVIII 

GENERAL EFFECTS OF REMEDIES AND DOSAGE 

Since a vastly important part of the nurse s work is the 
observation of symptoms, it follows naturally that the 
observation of the effects of remedies used for the allevia¬ 
tion or removal of those symptoms deserves careful study. 
While each drug used is supposed to have a distinct 
action and effect, there are rules that apply to drugs in 
general as regard effects with which a nurse should be 
familiar. 

Physiologic and Therapeutic Action.—All remedies 

are recognized as having a two-fold action—the physio¬ 
logic and therapeutic. 

By physiologic action is meant the ordinary immediate 









General effects of remedies and dosage 267 

effects produced in the tissues and organs of the body, 
without reference to disease. Thus, we know that am¬ 
monia is a powerful irritant to the skin, producing red¬ 
ness, blistering, and destruction of tissue. 

Therapeutic effects are those which manifest themselves 
in the relief or removal of the morbid conditions existing 
in the system. 

Immediate and Remote Effects.—The effects of reme¬ 
dies are also spoken of as immediate and remote, or pri¬ 
mary and secondary. For instance, the immediate effect of 
a dose of Epsom salts is an increase in the number of, and of 
fluid in, the stools. The secondary or remote effect might 
be the lessening of the flow of milk in a nursing mother, 
or the lessening or removal of a dropsical effusion in some 
portion of the system. 

Stimulants and Sedatives.—A large proportion of the 
drugs in common use have either a stimulant or sedative 
action on some part of the body. 

A stimulant (from stimulus, a goad) is a remedy used to 
excite any organ to greater activity. 

Sedatives are agents which exert a soothing influence 
on the system by lessening functional activity. 

Stimulants are variously classified and subdivided, 
according to the portion of the body affected. For in¬ 
stance, diuretics are stimulants to the urinary system; 
cathartics are stimulants to the intestinal tract. 

All stimulants are followed by a reaction or depression. 
In serious illness, where stimulation is called for, a steady 
stimulation is maintained by the use of frequent and 
regular doses till the emergency for which the drug is 
given is passed. 

Sedatives. —Under the term “ sedative” may be grouped 
a large group of drugs which are variously classified as 
anodynes, analgesics, hypnotics, narcotics, somnifacients, 
soporifics, and anesthetics. These remedies produce their 
effect through the nervous system, and drugs used for this 
purpose are always to be used with extreme caution. 

Local sedatives are applied externally for the relief of 


268 


THERAPEUTICS AND MATERIA MEDICA 


localized pain. Common examples of this class are ice, 
heat, and lotions containing opium. 

The nervous system and the organs of circulation are 
the channels through which medicines or remedies of any 
kind must produce their effect on the system. 

Conditions Modifying Drug Action.—A great many 
conditions may interfere with or reduce in extent or degree 
the action of any remedy: 

1. The actual condition of the individual at the time a 
drug is given. Drugs cannot be depended upon to pro¬ 
duce the same results in disease as in health. The con¬ 
dition of the stomach as well as the general condition of 
the body needs to be taken into consideration. When 
the stomach is empty, drugs act more rapidly. Many 
drugs should not be given on an empty stomach because 
of their irritant effect on that organ. If given after taking 
food, this irritant action is not produced. 

2. Surrounding conditions may modify the action of a 
drug, and in certain drugs may utterly defeat the object 
for which it is given. For instance, the effect of a sedative 
may be lost by the neglect to exclude visitors, or to darken 
the room, or to have the patient ready for sleep when the 
medicine is given. 

3. Incompatibility between medicines or between medi¬ 
cine and food. One drug may neutralize the effect of 
another. “In some cases drugs which are physiologic 
antagonists are prescribed, one as a guard against the 
action of the other, as in the hypodermic administration 
of morphin guarded by atropin.” 

4. Age modifies very decidedly the action of drugs. The 
delicate tissues of the infant or child render it exceedingly 
susceptible to the influence of drugs. The diminished 
resistive power of the aged is also taken into consideration. 
Strongly depressant drugs of any kind, and especially drugs 
which act powerfully on the nervous system, should be 
used with great care in the extremes of age. 

5. Sex. —As a general rule smaller doses are required for 
females than for males. This is especially true of drugs 


GENERAL EFFECTS OF REMEDIES AND DOSAGE 269 

which affect the nervous system, but is true of many 
other drugs, notably those which are regarded as specifics 
for certain diseases. 

6. Imagination .—Many individuals are very sensitive 
to suggestion, and the positive statement that a drug will 
do a certain work is a powerful aid to the action of the 
drug. In many cases if a patient knows what drug he 
is taking its effect will be lessened. The part played by 
imagination is clearly shown in the splendid results that 
frequently are obtained by the use of a placebo—an inert 
remedy given to satisfy a patient. Profound sleep is often 
induced by a hypodermic injection of water. Marvelous 
tonic effects are produced by pills made of sugar-of-milk, 
while pain is relieved and nervous symptoms allayed by 
similar means. 

7. Mode of Life .—Just as hot-house plants are more 
susceptible to external conditions than hardy outdoor 
plants, so individuals whose constitutions have been 
made stronger and more resistive by hard work and open- 
air life are less susceptible to the influence of drugs than 
those reared in luxury and weakened by lack of exercise. 
Body weight also needs to be considered. 

8. Habit .—Practically all medicines act more power¬ 
fully on one unused to them. A condition known as 
“toleration” follows the frequent use of many drugs and 
larger doses will be needed to secure the same effect. 
Common examples of this are seen in the effects produced 
on habitual users of alcohol and opium. 

9. Temperament .—Persons having a fine-strung nervous 
organism are usually more susceptible to the effects of all 
drugs, and comparatively small doses will often produce 
a depression or condition of excitability that seems out 
of all proportion to the dose given. 

10. Idiosyncrasy is a peculiarity of individual temper 
ament in which frequently such uncommon effects are pro¬ 
duced by some drugs that it is unwise ever to give them. 
A not unusual example of idiosyncrasy is the rash pro¬ 
duced on some individuals by a small dose of morphin. 


270 THERAPEUTICS AND MATERIA MEDICA 

Quinin, even in small doses, sometimes causes severe 
headache, with ringing in the ears. 

11. Size of Dose .—The size of the dose in many cases 
will determine its action. For instance, it is well known 
that whisky in small doses has a powerful stimulant action, 
and when taken in larger doses, or to excess, produces 
a profound stupor or sleep. 

12. Condition of the Drug .—The condition of the drug 
at the time it is given will very decidedly influence its 
effects. The medicinal properties of vegetable drugs may 
have been weakened by age, exposure to air, or other con¬ 
ditions, and a prescription made according to a given for¬ 
mula may fail of its effects for that reason. Two druggists 
may make up the same prescription. One medicine may 
be immediately effective, the other may seem to produce 
no definite action. This is one of the very common com¬ 
plaints of physicians. The freshness of vegetable drugs 
is important in serious cases where immediate effects are 
desired. Infusions soon decompose and need to be made 
up freshly every few days. 

Exposure to light and air will affect many drugs. A 
common example of this class is the solution of silver 
nitrate. In fact, most drugs prepared for use in the form 
of solution will become changed in composition in a com¬ 
paratively short time. 

Evaporation of the alcohol contained in tinctures and 
fluidextracts will increase the strength of the drug. Leav¬ 
ing bottles uncorked will affect a change on a great many 
drugs. 

Pills may become so hardened with age that they may 
pass undissolved through the whole intestinal tract. 

13. Adulteration of drugs has been perhaps one of the 
chief causes affecting the results of drugs. A notoriously 
common example is the adulteration of phenacetin, an 
imported, expensive drug, with acetanilid, a common, very 
cheap drug, resembling it in appearance. Substitution 
of a cheaper drug, instead of the one ordered, is another 
crime which has been practised to a considerable extent. 


GENERAL EFFECTS OF REMEDIES AND DOSAGE 271 

The pure food and drugs act has lessened materially the 
practise of adulteration, but the reliability of the druggist 
is often a matter for grave consideration in cases of very 
serious illness. 

14. Varied Action of Drugs .—A large number of drugs 
have several different effects, and many whose potency in 
one direction is unquestioned, have to be avoided because 
of the serious after-effects produced. For instance, opium 
(and its preparations) relieves pain, but it also lessens the 
secretions, producing constipation, a decrease in urine, 
and various other effects. Pilocarpin is a powerful drug 
producing profuse perspiration. It also reduces tempera¬ 
ture, depresses the heart, contracts the pupil of the eye, 
etc. 

In dividing drugs into classes, the principle action of 
the drug or its predominant quality usually determines 
the class in which it is placed, but the classification of 
drugs is one on which there are wide differences of opinion. 
For instance, one physician will claim that a certain drug 
should be classed as a digestant; another would class the 
same drug as a stomachic; and another, as a tonic. 

One will insist on classifying a drug as an analgesic, 
another as an anodyne, and another as a sedative. It 
is manifestly impossible for a nurse to keep posted regard¬ 
ing the variety of action of thousands of drugs. The class 
to which each may belong beyond that of the drugs in 
common use is not a matter of vital importance to her. 
She has a right to know the general effect the drug she is 
ordered to give is expected to produce. If she does not 
know, then she should inquire of the physician. Without 
this knowledge she cannot be an intelligent observer and 
ally of the physician. 

15. Accumulation. —Certain drugs have what is called 
a “cumulative effect.” That is, the body excretes them 
very slowly and they accumulate in the tissues. Common 
examples of this class are nux vomica and digitalis. 

Drug Rashes.—Gould gives the following list of drugs 
which sometimes produce a transient rash: Belladonna 


272 


THERAPEUTICS AND MATERIA MEDICA 


quinin, iodids, bromids, arsenic, chloral hydrate, tur¬ 
pentine, copaiba, digitalis, strychnin, acetanilid, and 
morphin. Other authorities mention ergot. 

Impairment of Hearing.—Quinin, antipyrin, and the 
salicylates may cause a buzzing or ringing noise in the 
ears. Temporary deafness is sometimes caused by quinin, 
but cases of permanent impairment are rare. 

The Therapeutic Limit.—In the giving of drugs there 
is recognized what is known as a therapeutic limit, a point 
beyond which it is not safe to continue the drug, at least 
not in as large doses. The therapeutic limit of the power¬ 
ful drugs in common use should be known. Of the follow¬ 
ing drugs it is said to be: 

Digitalis .—A slow, full pulse. It may fall to 40 beats 
a minute; vomiting, diarrhea, headache. 

Strychnin. —Trembling, twitching, stiffness of the mus¬ 
cles of the neck, and general nervousness. 

Nitroglycerin. —Throbbing headache, perspiration, diz¬ 
ziness. 

Bromids. —Extreme drowsiness, salty or metallic taste 
in the mouth, eruption of pimples. 

Iodids. —Headache; sore throat; general catarrhal symp¬ 
toms affecting the eyes and nose; salivation. 

Mercury. —Soreness of the mouth; fetid breath; saliva¬ 
tion; a metallic taste. 

Aconite. —Tingling, especially of mouth, lips, and mucous 
membrane; feeble, irregular pulse. 

Acetanilid. —Severe depression; cyanosis; feeble pulse. 

Arsenic. —Puffiness around the eyes; nausea; tightness 
about the throat. 

Opium. —Heavy stupor; contraction of the pupils; deep 
respiration. 

Chloral. —Slow, weak pulse. 

Sulphonal. —Pinkish tint of the urine. 

Atroyin. —Dilation of the pupils; dryness of the mouth 
and throat; weak, rapid pulse. 

Dosage.—The responsibility of a nurse regarding the 
dosage of medicines, generally speaking, begins and ends 


GENERAL EFFECTS OF REMEDIES AND DOSAGE 273 

with the administration of the dose in a proper way accord¬ 
ing to the physician’s orders. This is the rule, but, as in 
most other rules, there are occasional exceptions. A few 
exceptions may be mentioned. Ordinarily it is no part of 
a nurse’s business to question the size of a dose ordered. 
The responsibility for the size of the dose belongs to the 
physician. Neither is she responsible for the results of 
any remedy. But no physician is infallible. Mistakes 
do occur to which the physician’s attention should be 
called, as, for instance, when a physician’s attention was 
diverted while writing an order for strychnin, and the 
order read “strych. gr. J every three hours.” It was evi¬ 
dent that - 3 V was the dose intended. 

It is unnecessary to enumerate the various causes that 
have led to mistaken orders being given. Such orders as 
aconite to be given in 2 -dram doses and repeated in two 
hours; morphin in 5-grain doses for a baby; and strychnin 
in i-grain doses to be given every hour, have been written 
on hospital order-books for nurses to carry out. These 
are unusual, unfortunate conditions that have to be met 
only at rare intervals, and, perhaps, never by some nurses. 
Etiquette and custom have decreed that the nurse is to 
implicitly obey orders, but common sense and humani¬ 
tarian instinct have just as certainly decreed that loyalty 
to orders and unquestioning obedience, which are the rule, 
shall not be carried to the extent of causing serious injury 
or the death of the patient. The laws of God and man 
have decreed that “Thou shalt not kill.” Under such 
circumstances, or when in doubt, it is better to withhold 
the dose altogether till the error in the order can be recti¬ 
fied. 

Another exception to the rule would be when a drug 
was producing an effect which the physician could not 
foresee and evidently did not desire or intend. 

The medicinal dose of drugs is subject to great variation. 
The maximum dose which may be safely given and the 
minimum which will produce an effect have been deter¬ 
mined by experience, but so many considerations enter 


274 THERAPEUTICS AND MATERIA MEDICA 

into the effects in individuals that positive statements 
regarding proper doses are liable to be questioned, and 
authorities differ materially on the question. 

As the nurse administers doses of medicines she will 
learn the average dose. Time spent on cramming the 
doses of a long list of drugs will be time largely wasted, 
for experience has proved that neither medical students 
nor nurses really learn so that they retain knowledge of 
doses in that way. This is true as a main principle, but 
the average doses of the strongly poisonous and dangerous 
drugs in common use should be indelibly impressed on the 
memory as early as possible, so that an error may be 
quickly detected. In this list strychnin, morphin, lauda¬ 
num, paregoric, nitroglycerin, digitalis, acetanilid, nux 
vomica, aconite, and atropin should be included. 

It will be helpful also to remember the average doses 
of some of the different classes of drugs. 

Dilute acids (such as dilute hydrochloric acid) are usu¬ 
ally given in doses of Hlx to xxx. 

Fluidextrads are usually given in doses of fflx to xx. 

Potent tinctures, dose, lt|v to xv. An exception to this 
rule is in giving tincture of iodin internally, when the dose 
rarely exceeds TTliij- 

Solid extracts , dose, gr. { to j. 

Spirits, dose, Iffxv to 3j. 

Syrups, dose, Tffx to 3 iv. 

Infusions and decoctions, dose, 3j to sj. 

Dose for Children.—A common rule for computing 
doses for children under twelve years of age is: Add 12 to 
the child’s age and divide the age by the sum. For ex¬ 
ample, if a child is four years of age, the dose would be 
figured in this way: 4 ^ 2 = 16, ^ or J of the adult dose 
would be an average dose. This rule does not apply to 
castor oil nor calomel, of which larger relative doses are 
borne by children than of most other drugs. 


MEDICINES AND THEIR ADMINISTRATION 275 


CHAPTER XXIX 

MEDICINES AND THEIR ADMINISTRATION 

Medicines may be administered by the mouth, rectum, 
inhalation, subcutaneous injection, by inunction, by simple 
application to the skin, or by application to the mucous 
membrane. In cases of emergency the veins are sometimes 
utilized for the introduction of medicinal substances. 
The stomach is the route usually selected for securing 
the absorption of medicines. There are two reasons for 
this: one being its convenience, and the other that the 
facilities for absorption which exist in the walls of the 
gastro-intestinal tract, through the numerous blood-vessels 
and lacteals, render it possible for drugs to find their way 
into the current circulation with comparative rapidity. 
Unless otherwise ordered, it is usually understood that 
drugs are to be given by the mouth. Exceptions to this 
rule would be suppositories, which are never given by the 
mouth and are usually intended to be given by the rec¬ 
tum, unless contrary orders are given. 

Giving Medicines by the Mouth.—In giving medicines 
by the mouth much judgment must be used as to time. 
A great many conditions influence the time required for 
absorption. 

Drugs will more quickly enter the circulation if the 
stomach is empty. All drugs must be reduced to a solu¬ 
tion before absorption can take place, hence, it will be 
readily seen that medicines given in fluid form will act 
more quickly than in solid form. 

Pills having a hard coating require a relatively long 
time to produce an effect, and may entirely resist the ac 
tion of the digestive juices and pass undissolved through 
the whole intestinal tract. If there is a suspicion that this 
might occur, it is wise to crush the pill to a powder before 
giving it. The following general rules relating to the 
time of giving medicines may require that numerous ex- 


276 


THERAPEUTICS AND MATERIA MEDICA 


ceptions be made in individual cases, but will be helpful 
as a guide. 

General Rules—1. Give when the stomach is empty 
if rapid action is desired. 

2. Bitter tonics, designed to stimulate the secretion of 
digestive fluids, should be given shortly before food is 
taken. 

3 . Iron, being intended to supply to the blood an ele¬ 
ment in which it is deficient, should be given while diges¬ 
tion is in progress. Iron and arsenic are both somewhat 
irritant to the mucous membrane. 

4. Alkalies, such as soda, ammonia, and lithia, are best 
given before meals unless intended to neutralize an exces¬ 
sive secretion of hydrochloric acid. 

5. Acids and many other irritating substances should 
be given within one-half hour after food and should be 
well diluted. Give through a tube when possible. 

6 . Saline cathartics, such as Epsom salts, should be 
given one-half hour or more before meals, preferably in 
the morning. Pills and more slowly acting laxatives are 
best given at night when the stomach is empty. 

7 . Salol and remedies intended to act on the intestines 
instead of the stomach should be given between two and 
three hours after foods. 

8 . Cough medicines, diuretics, diaphoretics, heart ton¬ 
ics, and general systemic medicines are best given about 
midway between meals. 

9. Cod-liver oil and olive oil, being somewhat nause¬ 
ating, should not be given until digestion is almost or 
entirely completed. If taken but once a day, they are 
best given at bedtime. 

10. As a general rule, give a mouthful of water after all 
medicines. 

Pills .—If difficulty is experienced in swallowing pills, 
the addition of a small bit of bread to its bulk will usually 
remove it, or the pill may be disguised in preserved fruit 
for children. Pills should be placed far back on the 
tongue and followed at once by a little water. 


MEDICINES AND THEIR ADMINISTRATION 277 

Powders .—Effervescing powders or crystals are dissolved 
in cold water (usually at least one-half tumblerful) at the 
bedside and taken during effervescence. Powders, such 
as trional and sulphonal, may be dissolved in water or 
hot milk before giving, but are usually given dry on the 
tongue and followed with a drink of water. Bismuth and 
calomel are insoluble in water, phenacetin and acetanilid 
nearly so. These are best given dry on the tongue, to be 
followed with water. Carbonate of ammonia and iodid 
of potassium may be given in milk. Capsules, pills, and 
tablets are given from a spoon, followed by water. 

Oils .—The disagreeable 
taste of oils may be lessened 
in various ways. Castor oil 
may be given to children in 
hot milk or a little coffee. 

Whisky, wine, grape-juice, 
and orange or lemon flavor 
are favorite vehicles. 

It is better to moisten the 
sides of the glass with the 
wine or diluted juice, pour 
a couple of drams in the 
bottom of the glass, drop the 
oil carefully in the center, 
add another dram of the 
juice, and direct that it be 
swallowed quickly. A pow¬ 
der composed of gum arabic, 
licorice, and lactose, flavored with vanilla, is used as a dis¬ 
guise for oils in general in some hospitals. It is stated 
that a small amount of this powder shaken with a little 
water produces a persistent froth, which forms a very 
effective disguise for any oily substance. Ice-water, with 
a few drops of peppermint, taken before and after medi¬ 
cines helps to dull the sense of the taste. 

Turpentine and croton oil are best given on sugar, from 
a spoon, followed by water. 



Fig. 104.—Castor oil in glass ready 
for administration (De Lee). 





278 


THERAPEUTICS AND MATERIA MEDICA 


Fluid Medicines— 1. It is a general custom to dilute 
with water most fluid medicines, but judgment should be 
exercised as to the amount of w'ater that is added. It is 
unnecessary to prolong the unpleasantness of a disagree¬ 
able dose by adding too much water. 

2. It is a safe rule to shake all bottles before measuring 
the dose. In a great many mixtures the important part 
of the remedy is in the form of a sediment, the liquid being 
simply the vehicle used to convey it. 

3 . Bottles should be carefully corked after the dose 
is measured. Many medicines contain substances that 
readily evaporate. 

4. The regular graduated glasses and dropper should 
be used to measure. Spoons vary in size and are most 
unreliable measures. 

5. When minims are ordered, they should be measured 
in the minim glass. Minims and drops mean very different 
quantities in many medicines. 

6 . Measure exactly. Never guess at doses of any medi¬ 
cines. A great many nurses, who measure other medicines 
very carefully, guess at doses of whisky or brandy, and 
often twice the quantity intended is given. Hold the glass 
on a level with the eye when measuring. 

7. Always pour from the side of the bottle opposite 
the label. This is a well-known rule that is often dis¬ 
regarded. 

8 . Give iron through a tube, as it discolors the teeth. 
If no tube is obtainable, and it has to be given without, 
allow the patient to brush his teeth with a solution of soda 
bicarbonate and water afterward. 

9. A little ice held in the mouth before a disagreeable 
dose helps to dull the sense of taste and renders it less 
unpalatable. Vichy or seltzer are excellent for removing 
a disagreeable lingering taste. 

10. Always keep a separate glass for very strong-smell¬ 
ing substances, such as cod-liver oil. 

General Precautions.—Familiarity with drugs is apt 
to lead to carelessness in handling and using, unless em- 


MEDICINES AND THEIR ADMINISTRATION 279 


phatic teaching and instructions are given. Drug acci¬ 
dents in hospitals are, unfortunately, not rare. Deaths 
from wrong doses do occur, not because nurses have not 
been taught correct methods, but because they are not 
sufficiently careful. If the following general precautions 
regarding all drugs are observed, accidents from wrong 
doses will rarely, if ever, happen: 

1. Remember that there is an element of danger in 
every drug. 

2 . Read your orders very carefully and be sure that 
you understand them. A great many omissions and 
blunders occur from neglect to read orders or from a 
hasty, careless reading. 

3. Never give or use a drug of any kind that is not 
plainly labelled. 

4. Never give a drug in the dark or in a dim light. 
Neglect of this precaution has caused numerous accidents. 

5. Always read the label twice before pouring out the 
dose and again before giving it. Violation of this rule is 
the most frequent cause of deaths from wrong doses. 

6 . Keep your mind on the work in which you are 
engaged. 

7. Measure the dose accurately. Give no more and no 
less than the order calls for. 

8 . Never give a pill, capsule, or tablet that has acci¬ 
dentally been spilled or escaped from its container. 

9. Never give a medicine which you have a shadow of 
a doubt about. If you are not sure, and there is no one 
at hand to inquire of, it is better to omit the dose. 

10 . Never jump at conclusions regarding fractional 
doses. For instance, do not give two g^-grain tablets of 
strychnin because -gV is ordered, and you happen to know 
that twice 30 are 60. Stop long enough to calculate how 
much grain really is. Innumerable accidents have 
occurred with tablet medicines in this way because of 
mistakes in arithmetic. 

11 . Give the medicine on the hour it is ordered. If 
several patients are to be given medicine at the same hour, 


280 THERAPEUTICS AND MATERIA MEDICA 

begin shortly before the hour, so that all may have their 
medicines at the appointed time. 

12 . Be exceedingly careful to see that the doses of medi¬ 
cines for the patients in a ward are not given to the wrong 
patients. 

Verbal orders given by physicians to pupil nurses re¬ 
garding drugs should always be at once written down, and 
should never be carried out unless passed on by the resident 
physician or head nurse. 

Sleep-producing Medicines.—Practically all sleep- 
producing medicines are ordered conditionally. There is 
a subtle danger in every one of them that is recognized 
by all who have had experience, and they are regarded 
as emergency remedies to be given if the need is imperative, 
and after ordinary simple measures to secure sleep have 
been tried and proved unsuccessful. When it is necessary 
to give them, have the patient ready for sleep, treatments 
all attended to, bed thoroughly comfortable, temperature 
of the room right, visitors excluded. If these have to be 
attended to after the dose has been given, it may have 
lost its effect before the patient is allowed to sleep. 

Giving Medicines to Children.—In the case of children 
who lie in a half-unconscious condition, it is impossible to 
give medicines in the ordinary way. Much can be accom¬ 
plished in these cases by using a medicine-dropper and 
taking plenty of time. The mouth and teeth can be heid 
open slightly and the medicine slowly dropped in. Usu¬ 
ally, with children, it is sufficient to insert the dropper 
beside the teeth, and when the contents are slowly dropped 
they will usually be swallowed. 

Each sick child is more or less of a problem, but there 
are a few general principles that apply to children as a 
class. Sometimes firmness and insistence on being obeyed 
will be all that is needed in giving medicine. When that 
fails, bribery of some form will often succeed. It is not 
good moral training to bribe a child to do what he mani' 
festly should do without bribery, but sickness is not the 
time to teach good habits. If a child is persistently ob* 


MEDICINES AND THEIR ADMINISTRATION 281 

stinate, it is unwise to spend time in pleading or arguing. 
The last resort in such cases, if it is important for him to 
get the medicine, is to hold the nose and give the medi¬ 
cine. Wrap a bath-towel about the body to confine the 
arms, hold the nose gently, and when the mouth is opened 
for breathing, insert the spoon as far back in the mouth 
as possible, empty slowly, and withdraw it. If a child 
persistently struggles and resists, the matter is one to be 
reported to the physician. Very often the struggle and 
consequent exhaustion will overbalance any good the 
medicine might do. 

In giving medicine to young babies, press the chin 
backward and downward with the finger, and the mouth 
will usually be opened sufficiently to pour in the medicine 
gently. 

Alcoholic stimulants should be diluted eight times before 
administration to children. 

Belladonna often causes a temporary rash, but is not 
necessarily injurious on that account. 

Bromids and chloral are best given to children by the 
rectum. As a rule, children do not bear opium, iron, or 
acids well. Calomel, quinin, bromids, chloral, and alco¬ 
holic stimulants are usually well borne. The iodids, bro¬ 
mids, and arsenic are apt to cause an eruption resembling 
acne. Occasionally chloral and quinin will cause a reddish 
rash. 

Delirious Patients.—In cases of low-muttering deli¬ 
rium and semistupor, the medicine will usually be swal¬ 
lowed if slowly introduced well back in the mouth. If the 
delirium is of a violent, resistive type, two nurses will usu¬ 
ally be necessary, one to control the patient's move¬ 
ments, the other to give the medicine. The teeth can be 
forced open and held apart (a clothespin or toothbrush 
handle are often used for this purpose) and the medicine 
can be slowly dropped well back in the mouth. The sub¬ 
cutaneous route is preferable, as far as possible, in these 
cases. Occasionally, less resistance will be offered to 
administration by rectum than by mouth. 


282 THERAPEUTICS AND MATERIA MEDICA 

Insane Patients.—With some insane patients no diffi¬ 
culty is experienced in giving medicines. They take with 
pleasure the most disagreeable doses and ask for more. 
Others obstinately refuse everything that is offered when 
they badly need them. Three questions then present 
themselves: Is it better to omit the medicines altogether, 
to use force, or to try to deceive the patient into taking 
them? Deceiving the patient is rarely recommended and 
usually fails, especially if the medicine has to be continued 
for any length of time. It may succeed with a single dose. 
Introducing the drug into the food may cause him to refuse 
food when nourishment is of the utmost importance. 
Delusions that food is being poisoned are common, and 
this method should never be used with such cases. As a 
general rule, it is better to be open and frank and admit 
that the dose is medicine. Tact will often accomplish 
much in these cases and patience is a prime necessity. 
Force should not be resorted to. In these, as in delirious 
patients, the hypodermic method is often preferable where 
it can be used. 


CHAPTER XXX 

MEDICINES AND THEIR ADMINISTRATION ( Continued ) 

Rectal Medication.—The rectum is used as a means 
of administering medicines in case of inability to swallow, 
also when the stomach is easily irritated, and is frequently 
preferred to other methods in dealing with sick children. 

Absorption by the rectum is slower than by the mouth. 
Much care and judgment needs to be used in giving medi¬ 
cines in this way. The rectum is easily irritated, soon 
becomes intolerant, and, unless properly given, medicines 
are liable to be rejected. 

In the hands of a skilled nurse, who is careful of every 
detail that may effect the retention and absorption of 



MEDICINES AND THEIR ADMINISTRATION 283 


the remedy, rectal medication and nutrition may some¬ 
times be continued without difficulty for some time, but no 
method of giving medicine requires more skill and care 
than this. 

General Rules .—Remedies for administration by injec¬ 
tion into the rectum require to be incorporated in some 
solution. The temperature should be about 100° F., if 



Fig. 105.—Rectal irrigator. A simple funnel will answer as well (De Lee). 

the remedy is to be retained. As a rule, 2 ounces are 
as much as is likely to be retained and absorbed by the 
rectum. A larger amount can be given if carried up into 
the colon. The rectum should be free from mucus or 
feces before giving the medicine. If there is irritability 
of the rectum, it should be relieved before the injection 
is given. Time should be allowed for the complete ab- 





284 


THERAPEUTICS AND MATERIA MEDICA 


sorption of one dose before another is given. Fats and 
starches are rarely absorbed from the rectum, and it should 
be remembered that fat, by forming a coating over the 
mucous membrane, may prevent absorption of other sub¬ 
stances. Alcohol, if frequently used, is liable to cause 
irritation. 

Opium in the form of laudanum is occasionally given 
as an aid to retention. When used, the minimum dose 
that will produce the desired effect should be given, as 
it prevents absorption. 

Position .—The best position, if the medicine is to be 
absorbed from the rectum, is on the left side with the hips 
elevated. If the medicinal fluid is to be carried up into 
the colon, the right side is preferable. The reason for the 
change in position is the abrupt turn in the course of the 
bowel. The reason for choosing the left side in the first 
place is that the fluid may by the natural force of gravity 
follow the course of the bowel to the left. After the sig¬ 
moid flexure is passed, the colon is arranged like the three 
sides of a square. It follows that if the left side is chosen 
for the introduction of fluids that are to be absorbed from 
the rectum, then the back or the right side is preferable 
when the fluid is to be absorbed from the colon, otherwise 
the fluid is forced to make progress against the force of 
gravity. The fluid will thus have a tendency to flow 
backward, distend the lower bowel, and be more quickly 
rejected. 

When the condition of the patient permits, the knee- 
chest position is recommended, especially in dealing with 
nervous or hysteric patients and when a large amount 
of fluid is to be given. All fluids, to be retained, should be 
given slowly, and the tube inserted and removed-very 
slowly and gently. Glycerin should not be used as a 
lubricant. Care should be taken to avoid air entering 
the bowel. A folded towel pressed against the anus after 
the tube is withdrawn is an aid to retention. 

Suppositories as a means of rectal medication are used 
chiefly for the relief of pain or as a local antiseptic in case 


MEDICINES AND THEIR ADMINISTRATION 285 


of rectal ulcers or following rectal operations. Occasion¬ 
ally glycerin is used in the form of suppositories as a 
laxative. The suppository is intended to melt at body 
temperature, and if stored near a heated radiator or chim¬ 
ney will quickly loose shape and be unfit for use. 

Having lubricated the suppository, it should be very 
gradually inserted into the rectum. It is less likely to be 
immediately rejected if it is passed well up beyond the 
sphincter muscle, using the index-finger covered with a 
rubber finger-cot or a small smooth instrument for that 
purpose. 

Hypodermic Injections.—The introduction of medi¬ 
cines by hypodermic injection is resorted to when rapid 
action is desired and in case of irritation of the stomach. 



Fig. 106.—Method of giving a hypodermic injection (Thornton). 

Usually powerful drugs in concentrated form are given 
in this way. All such drugs are made with special care 
under aseptic precautions, and care should be used to keep 
them as pure as possible. 

Morphin, atropin, codein, strychnin, digitalis, nitro¬ 
glycerin, and a few other drugs are prepared in tablet 
form for hypodermic use, while ergot and adrenalin are 
in fluid form. 

To give these injections a hypodermic syringe is needed, 
which also should be made as nearly aseptic as possible 
before use. The hollow needle should be kept in good 
condition, so that it is neither blunt nor the opening 
blocked. All needles should have the wire inserted after 
using. The washers, if there are washers, should not 




286 


THERAPEUTICS AND MATERIA MEDICA 


be allowed to dry up. Before using, the needle should be 
sterilized. A convenient method is to boil in a spoon for 
two minutes in a little water, first wrapping the needle 
with a bit of absorbent cotton. This provides at once 
a sterile spoon in which to dissolve the tablet and also 
the sterile water needed. The needle is removed and suf¬ 
ficient water drawn from the spoon into the syringe to dis¬ 
solve the tablet. The spoon is then emptied, the tablet 
placed in it, and the sterile water from the syringe poured 
on it to dissolve it. All particles of the tablet should be 
dissolved before injecting it. About 15 minims is an 
average quantity of water to use. 

The parts of the body selected for the injection are usu¬ 
ally the outer surfaces of the thighs, legs, or arms. Female 
patients usually prefer that the legs be used, as it may 
leave a scar on the arms. Bony prominences, parts on 
which there is liable to be much pressure, the exposed 
parts of the body, and proximity to blood-vessels are to 
be guarded against. The part selected should first be 
cleansed by rubbing with alcohol, using a clean gauze or 
cotton sponge. A piece of the muscle is picked up with 
the left hand. The air is expelled from the syringe by 
pushing on the piston point till a bubble appears at the 
point of the needle. It is then inserted quickly in an 
oblique direction deep into the tissue, slightly withdrawn, 
and the fluid injected. Pressure with a clean sponge 
should be made for a moment over the opening. The 
syringe and needle are then cleansed by using alcohol or 
carbolic acid solution and the wire replaced in the needle. 

Inhalation.—Medicines are given by inhalation, both 
for local effect on the air-passages and for systemic effect. 
The drugs most frequently given by inhalation are chloro¬ 
form and ether given for anesthetic purposes, but the ad¬ 
ministration of these drugs is out of the province of the 
first-year pupil nurse. 

Steam inhalations are given to children in cases of croup, 
bronchitis, diphtheria, and often in pneumonia. They 
are frequently used for the relief of the congestion caused 



Croup-tent for steaming and calomel-fumigation (Northrup): i. Croup-tent 
open. The fumigation-apparatus, standing on the table, consists of a Bunsen 
burner, a tripod, and a plate containing calomel. 2. Calomel-fumigation: croup- 
tent closed, nurse watching the child while fumigation is going on 

287 

























288 


THERAPEUTICS AND MATERIA MEDICA 


by a “ cold in the head.” When needed for the latter 
purpose, a pitcher of boiling water and a small blanket or 
bath towel will be needed. The medicine is poured into 
the boiling water. The head is held over the vapor and 
the blanket wrapped around all to confine the steam. 

Croup Tent .—Where it becomes necessary to keep the 
atmosphere moist continuously, a croup tent is employed. 
The steam is generated in a kettle on a gas or oil stove, 
or electric heater, close to the bed. A tent is formed over 
the bed with a sheet. The steam is conducted from the 
spout of the kettle under the tent by means of a long cone 

or tube made of stiff paper. 

Dry inhalations are required occasionally for the. relief 
of asthma. Various narcotic substances are often incor¬ 
porated in the form of cigarettes. Occasionally dried 
leaves or herbs are burned. The leaves can be placed in 
the bottom of a deep cup and a paper or pasteboard cone 
fitted over it, having an opening in the center, through 
which the vapor is inhaled. 

Oxygen is administered by inhalation when for any 
reason the patient is unable to inhale sufficient from the 
atmosphere for the immediate needs of the system. 

It is a valuable but expensive remedy, the methods of 
administering which all nurses should become familiar 
with. Oxygen is contained in steel cylinders which vary 
in size and general mechanism. The principle on which 
the oxygen outfits are arranged is practically the same, 
though the appearances differ. The stop-cock which con¬ 
trols the flow of gas is sometimes a wheel, in others a 
handle. Usually in large cities the drug firm supplying 
the oxygen will either send definite directions as to the 
regulation and use of the apparatus or send an agent to 
adjust it if necessary. The oxygen is passed through a 
bottle containing water, which serves as a guide m com¬ 
puting the amount consumed and in regulating the flow. 
The cylinder containing the oxygen is placed close to the 
bed. A long rubber tube connects it with the oxygen 
bottle. The bottle should have a fairly wide mouth with 


MEDICINES AND THEIR ADMINISTRATION 


289 


a rubber stopper. Two holes are made through the stop¬ 
per, through which two bent glass tubes are inserted, one 
slightly longer than the other. The rubber tube connected 
with the faucet is fastened to the longer of the glass tubes, 
which should project well into the water. Another rubber 
tube attached to the shorter glass tube conveys the oxygen 
to the patient by means of a glass or hard-rubber nozzle 



Fig. 107.—Inhalation apparatus of the S. S. White Dental Manu¬ 
facturing Company: A, represents the cylinder filled with compressed 
oxygen; B, the gas valve; C, a rubber bag, holding one gallon; D, a wash- 
bottle half filled with water; E, a mouthpiece attached by a rubber tube 
to a short glass tube which passes through the cover of the bottle, but 
does not extend down to the surface of the water; F, a rubber tube con¬ 
necting the rubber bag and the valve B; G, a rubber tube connect¬ 
ing the bag with the wash-bottle by means of a glass tube which extends 
through the cover nearly to the bottom. 


held in the mouth; or it may be preferable to fit a funnel 
to the end of the tubing instead of the noz.zle, and allow 
the oxygen to be diluted with air before being inhaled. 
The bubbles formed as the oxygen passes through the 
water will indicate the flow. The stop-cock should be 
turned on very slowly and the volume increased very 
gradually. It should be regulated till only very small 

19 












290 


THERAPEUTICS AND MATERIA MEDICA 


bubbles are produced. Bungling in the management of 
the flow of the gas may result in great waste. The phy¬ 
sician will give definite directions as to how long the inha¬ 
lations are to be continued, and the faucet should be tightly 
closed the moment the inhalation ceases. 

The oxygen outfit has become a necessity in the modern 
practise of medicine, but it should not be necessary to 
remind a nurse that the natural method of securing the 



oxygen for the patient is the most desirable. To shut out 
the natural supply of oxygen by closed doors, windows, 
and ventilators, and then try to restore the patient by 
artificial means is an absurd proceeding. 

Amyl nitrite is another emergency remedy usually given 
by inhalation. The drug is prepared in thin glass globules 
called pearls. Each pearl contains 3 or 5 minims, and 















































MEDICINES AND THEIR ADMINISTRATION 291 



usually one pearl is considered a sufficient dose. The 
pearl is crushed in a small towel or handkerchief and held 
over the nostrils. It is used in heart failure from anes¬ 
thetics, to relieve the spasms of tetanus, angina pectoris, 
and, occasionally, in convulsions. 

Camphor is another drug often given by inhalation, the 
drug being dropped on a napkin or inhaled from a bottle. 

Applications to the Eye.—The eye lotion is used either 
in the eye-bath or by dropping into the eye. In the eye- 
bath the solution is used as hot as can be borne. The 


Fig. 109.—Method of syringing eye. The cotton held against the nose 
should prevent any infection of other eye (McCombs). 

eye is submerged in a small glass filled with the solution. 
The average duration of the eye-bath is five minutes for 
each eye. Simple inflammation of the eyes from dust 
or other irritation is often relieved by an eye-bath in 
water without the addition of drugs. 

In dropping medicines into the eye the patient should 
throw the head back as far as possible or lie down and 
look upward. The lower lid is drawn slightly downward 
and the medicine dropped in the inner corner of the eye. 












292 


THERAPEUTICS AND MATERIA MEDICA 


The lid should not be closed or the lotion will be forced out. 
The eyeball should be slowly moved about to diffuse the 
fluid over the whole eye. 

In washing away a discharge from the eye, the solution 
should be applied at the corner of the eye nearest the nose, 
and the discharge always wiped away from the other eye, 
never toward it. In using a syringe to cleanse the eye, 
hold a piece of cotton as protector over the other eye. 

When it becomes necessary to apply medicine to the 
lining membrane of the eyelids, the lids must be turned 
outward. The upper lid is everted by directing the patient 
to look downward, gently grasping the lid, drawing it 
down, and rolling it back on itself. If difficulty is ex¬ 
perienced, a toothpick or similar instrument placed across 
the eyelid before it is rolled outward and back will make 
it easier. 

To expose the lining of the lower lid the patient should 
look upward while the lower lid is drawn down. In this 
way foreign bodies can be easily seen and removed. 

Mydriatics are drugs which dilate the pupil of the eye. 
Those most frequently used are atropin, belladonna, 
duboisin, and cocain. 

Myotics are drugs which cause contraction of the pupil 
of the eye. Eserin is the one chiefly used in ophthalmic 
work. Opium, pilocarpin, carbolic acid, internally, and 
anesthetics at the last, all have the effect of contracting 
the pupils. Strychnin is said to increase the sensibility 
of the eye and render the vision more acute. 

Giving Medicine Through the Skin.—Medication by 
simply placing the drug in contact with the skin is used 
mainly for producing counterirritation or for soothing 
purposes when the skin is irritated, as in sunburn, slight 
burns, etc. Tincture of iodin and mustard, in the form 
of paste or leaves, are common examples of the former, 
and cold creams, ointments, etc., of the latter. 

Inunction .—The introduction of medicines through the 
skin by means of friction is a common method of adminis¬ 
tering oils, liniments, and ointments. Where inunction 


MEDICINES AND THEIR ADMINISTRATION 293 

is ordered for systemic purposes, it is usually applied to 
the inner surface of the thigh or arms and to the axillary 
area, from which absorption is more rapid than from other 
parts of the body. Where inunctions are ordered to pro¬ 
mote nutrition in infants, olive oil is commonly used, and 
the whole body gone over. The skin can only absorb a 
certain quantity, and care is needed to avoid applying an 
excess of the oily substance. 

The fly-blister is a remedial agent that is not often called 
for, but its use has not entirely been abandoned. Many 
physicians still prescribe it for cases of meningitis, pleurisy, 
diseases of joints where there is effusion, and for chronic 
pain in different parts of the body. It is said to be of 
value for four purposes: “To counteract inflammation 
or congestion; to cause absorption of inflammatory de¬ 
posits after inflammation has ceased; to relieve chronic 
pain; and for general effects on the system in certain 
constitutional diseases.” 

It is not always applied directly over the seat of the 
inflammation, but rather with reference to the nerve 
endings. For instance, in intercostal neuralgia the blister 
is frequently applied over the vertebra, where the affected 
nerve makes its exit. The exact location and area to be 
covered by the blister should be definitely ascertained 
from the physician. 

The part should be cleansed and shaved if there are any 
hairs to be seen. The blister, cut the exact size, can be 
secured in place by a bandage. The blister should rise 
in from four to seven hours, but occasionally, where the 
skin is very thick, it takes longer. The application of a 
hot poultice to the part after the blister agent has been 
removed will sometimes be necessary in those cases. 
The blister should be carefully watched and removed 
gently at the time ordered. Sometimes the fluid in the 
blister is allowed to remain undisturbed to be reabsorbed, 
but the customary method is to make a slight incision at 
the lowest point, allow the watery fluid to escape, and 
apply a simple unirritating dressing. Cantharidal col- 


294 THERAPEUTICS AND MATERIA MEDICA 



lodion is a blistering agent which is applied by painting on, 
as with tincture of iodin. 

Insufflation is a method used in applying powders to 
various parts of the respiratory tract by means of a rubber 
bulb attached to a receptacle containing the P°wder. Its 
use is confined mainly to the nose and throat. The atom- 


Fig 110.—Method for syringing ear with fountain syringe. The lower 
end of bag should not be above level of auditory canal (McCombs). 


izer or spray is used for treating the same parts of the body 
with fluids. 

The douche is a common method of applying medicated 
substances in solution to the mucous membrane of various 
parts of the body. Its chief uses are to check hemorrhage, 
to relieve pain, to check secretions, to cleanse, and to 
stimulate. 













EVACUANTS AND INTESTINAL ASTRINGENTS 295 


The nasal douche is occasionally used, but it has very 
limited utility. Only a small part of the mucous mem¬ 
brane of the nasal passages is reached in this way. The 



. Fig. 111.—Method for syringing nose. The syringe is introduced 
into upper nostril, the solution escaping from opposite nostril or mouth 
(McCombs). 


ear douche, the vesical, vaginal, rectal, and colonic douche 
are all valuable therapeutic agents, the correct technic 
of which should be understood by every nurse. 


CHAPTER XXXI 

EVACUANTS AND INTESTINAL ASTRINGENTS 

Evacuant is a term used interchangeably with cathartic 
or purgative. It has, however, a broader meaning. Some 
medical writers have used it in grouping together emetics, 











296 


THERAPEUTICS AND MATERIA MEDICA 


cathartics, anthelmintics, and diuretics, while Webster 
defines evacuation as the “voidance of any matter by 
the natural passages of the body or by an artificial open¬ 
ing, also a diminution of the fluids of an animal body by 
cathartics, venesection, or other means.” In the study 
of special drugs it may be well to begin with the common 
evacuants and the general remedies which are used for 
increasing the activity of the bowels, urinary system, and 
the skin. 

Cathartics are remedies used to increase the peristaltic 
action of the bowels. Of these there are various subdi¬ 
visions. 

Laxatives or aperients are cathartics having a mild 
action, exciting moderate peristalsis, and producing soft¬ 
ened stools without irritation. In this class there are 
many simple natural remedies which all nurses should be 
familiar with, the use of which will often be left to the 
nurse’s judgment. Drugs should not be used when nat¬ 
ural remedies will accomplish the desired result. 

The normal condition regarding bowel movement 
is that each individual should have at least one evacuation 
of the bowels each day. There are various deviations 
from this rule in the way of increased movement, which 
up to a certain point do not affect the general health, but 
if at least one bowel movement does not take place each 
day the health is sure, sooner or later, to suffer from 
retention of waste products in the system. 

Habit is a strong controlling factor in this matter, and 
an effort to empty the bowel at a regular time each day 
should be made until the habit is established. 

Water .—Copious drinking of pure water tends to pro¬ 
mote the normal action of the bowels, but too much water 
should not be used at meals. For laxative purposes, a 
glass of either hot or cold water, with or without the addi¬ 
tion of a pinch of salt, taken on rising in the morning, 
proves a sufficient remedy in a great many cases. 

Food .—The character of the food also has a decided 
action on peristalsis. A great many vegetables have 


EVACUANTS AND INTESTINAL ASTRINGENTS 297 


a tough woody fiber which, though indigestible, performs 
a useful function in contributing to the bulk of food needed, 
and thus stimulates peristalsis. Of these, green corn and 
turnips are examples. Coarse cereal foods, such as hominy, 
oatmeal, and crushed wheat, brown bread, and bran bis¬ 
cuits, all have a slight laxative effect. The addition of 
cream to an infant’s food will often correct any tendency 
to constipation. 

Fruits act as laxatives through their seeds and through 
the action of the acids and salts they contain. For lax¬ 
ative purposes fruits should be eaten between meals and 
on rising in the morning. The laxative action is increased 
if the fruit is followed with a glass or two of water. Pre¬ 
served fruits are not so effectual as fresh, and bananas 
are said to cause constipation. The-following list of fruits 
have a laxative effect: Prunes, oranges, grapefruit, apples, 
cooked or raw, peaches, berries. 

Buttermilk, apple cider, koumiss, honey, rhubarb, wal¬ 
nuts, almonds, and fresh green vegetables are all useful 
articles of diet when there is a tendency to constipation. 

Exercise .—Active exercise of the body tends to pro¬ 
mote the normal action of the intestines. Those who 
lead a sedentary life or are confined to bed require that 
special care in diet be used if constipation is to be avoided. 

Massage of the abdomen is used with especial benefit 
in children, where natural simple measures are not suffi¬ 
cient to produce a normal action of the bowels. Begin 
at the right groin and follow the course of the colon around 
the abdomen. 

Simple purgatives are used to secure active peris¬ 
talsis. Usually these produce one or more free semifluid 
movements, with, occasionally, griping and irritation. 
Common examples of this class are cascara, castor oil, 
olive oil, calomel, licorice powder, compound rhubarb 
pills, and aloin, strychnin, and belladonna pills, of which 
there are a number of varieties. The ordinary soap-suds 
enema would also come in this class. 

Castor oil {oleum ricini) is one of the best and most 


298 


THERAPEUTICS AND MATERIA MEDICA 


nauseous of the simple purgatives. It is obtained from 
the bean of the castor-oil plant. It is regarded with favor 
partly because of its bland, soothing, unirritating qualities, 
making it a very desirable purgative for infants and aged 
people, also where the intestinal tract is already irritable 
from the presence of putrid food, and in diarrhea or dys¬ 
entery. 

Olive oil (oleum olivce) is a nutritive food having a 
laxative effect. It is used extensively as a salad dressing, 
but the taste for it as a food has to be acquired. It is a 
good laxative for infants and for poorly nourished adults. 
It is frequently used by injection into the rectum to soften 
fecal discharges and is a valuable intestinal remedy in cases 
of dysentery and inflammation of the colon with a mucous 
discharge. Adulteration of olive oil is frequent, cotton¬ 
seed oil being used extensively for this purpose. Olive 
oil is obtained from the fruit of the olive tree. Much of 
the best olive oil is imported from Italy, but adulteration 
is so common that in many preparations the less expensive 
cotton-seed oil is directed to be used. 

Cascara (rhamnus purshiana) is a very mild cathartic, 
especially valuable in constipation. It does not cause 
constipation afterward, as do many other cathartics. 
In small doses it has a non-irritating tonic action on the 
intestines. There are various preparations which differ 
markedly in potency. 

Compound licorice powder (pulvis glycerrhiza compositus) 
is a mixture of senna, sulphur, licorice root, and other 
ingredients. Senna is the most active ingredient. It 
resembles castor oil in its action and is more agreeable 
to take. It is given mixed with a little water and should 
be followed by a larger quantity of water. 

Calomel (hydrargyri chloridum mite) is frequently given 
combined with some other drug, usually soda bicarbonate. 
If taken alone it is slow in action, and small, oft-repeated 
doses are considered preferable to one larger dose in a 
great many cases. It is considerably used as a remedy 
for children in cases of digestive disorders, foul breath, 


EVACUANTS AND INTESTINAL ASTRINGENTS 299 

jaundice, etc. In large doses or if long continued it is 
apt to produce salivation. It is an important ingredient 
of the blue mass pill. Both calomel and blue mass are 
favorite remedies in so-called “biliousness.” 

(Symptoms of salivation are fetid breath, swollen and 
spongy gums, sore and loosened teeth, increased secretion 
of saliva, headache, and insomnia.) 

Aloin, strychnin, and belladonna pills, in all their numer¬ 
ous combinations, are frequently employed in constipa¬ 
tion for their laxative and tonic action. Aloes acts especi¬ 
ally on the lower intestine, slightly increases the flow of 
bile, and does not tend to constipate as an after-effect. 

Compound rhubarb pills are a combination of rhubarb 
with aloes and oil of peppermint. Rhubarb (rheum) has 
a tonic, laxative, and astringent effect, its astringent 
properties being exerted after its purgative effect. It is 
considered useful in chronic constipation and dyspepsia 
for its tonic effect. 

Drugs which Produce Watery Stools.—In this class 
would be placed Epsom salts, Seidlitz powder, citrate of 
magnesia, and various other concentrated or specially 
prepared salts; also saline mineral waters, such as those 
found at Saratoga Springs, New York, in Michigan, 
Ontario, and various other parts of the American conti¬ 
nent. 

Apenta, Abilena, Apollinaris, and Hunyadi Janos are 
familiar examples of imported mineral waters used for 
this purpose. 

Compound jalap powder, elaterium and croton oil, are 
more drastic in action, and comparatively seldom used. 

Croton oil (oleum tiglii) has a powerful and rapid action, 
and its use is usually followed by a very decided phys¬ 
ical depression. 

The dose rarely exceeds 2 drops, and often only \ drop 
is given. It may be given dropped on sugar or mixed 
with glycerin. 

Elaterium (elaterinum) has a powerful action, producing 
excessive watery stools in a short time. It also is followed 


300 


THERAPEUTICS AND MATERIA MEDICA 


by extreme prostration and stimulation may be needed 
to counteract the exhaustion. There are two or three 
preparations of this drug of different potency. The 
average dose of elaterin is gr. 

Jalap (jalapa) is used frequently in cases where there 
is a dropsical effusion, and in cases of sluggish liver. It 
is one of the ingredients of the compound cathartic pill, 
and is often combined with calomel. Compound jalap 
powder is a mixture of one-third jalap and two-thirds 
cream of tartar. 

Epsom salt (magnesii sulphatis) is contained in many 
mineral spring waters. It is produced by the chemical 
combination of sulphuric acid and carbonate of magnesia. 
It is given cold, dissolved in water, well diluted, and 
though disagreeable to the taste, is well borne by the 
stomach. The dose varies greatly, 2 ounces being about 
the limit. A favorite method is to give in small doses 
frequently till the desired action is produced. 

Citrate of magnesia (magnesii citratis) is a combination 
of carbonate of magnesia and citric acid. It is prepared 
both in powder form and in solution, both being effer¬ 
vescent. The granular powder needs to be kept in a dry 
place, well corked, or its effervescing properties will be 
lost. The solution should be kept in a cool place and 
taken as soon as possible after being poured out. 

Seidlitz powder is a combination of Rochelle salts, 
soda bicarbonate, and tartaric acid. It is usually pre¬ 
pared in white and blue papers. The white paper contains 
2 drams of Rochelle salts and 40 grains of soda bicarbonate; 
the blue, 35 grains of tartaric acid. The contents of the 
papers are dissolved in cold water in separate glasses. 
Before giving it to the patient they are mixed, which pro¬ 
duces effervescence, and the mixture should be taken before 
the effervescence subsides. 

Anthelmintics are agents used to cause the expulsion 
of intestinal worms. The term is used interchangeably 
with vermifuge. 

Santonin (santoninum) with calomel is the remedy most 


EVACUANTS AND INTESTINAL ASTRINGENTS 301 

used for the round-worm that sometimes inhabits the 
small intestine. This remedy has no effect on the tape¬ 
worm. If the calomel is not effective in producing a 
bowel movement, it should be followed with castor oil or 
a saline purgative. Pumpkin seeds are occasionally used 
when tapeworm is suspected. 

Vermicides destroy intestinal worms. For thread¬ 
worms and round-worms solutions of alum, salt, lime- 
water, and quassia are often given by enema. 

Carminatives assist in expelling gas from the stomach 
and intestines, slightly increase peristalsis, and stimulate 
circulation. They exert a soothing and relaxing effect 
on the tissues. Common examples are peppermint, 
ginger, capsicum, and cardamom. Asafetida is given 
both in pill form and solution. When used in enemata, 
the milk of asafetida is given. Turpentine is given by 
mouth, combined with other drugs, or by enema, for this 
purpose. 

Intestinal astringents lessen the discharges from the 
bowels, contract tissue, including the walls of the intesti¬ 
nal blood-vessels, and diminish the fluids of the intestines. 

Bismuth subnitrate (bismuthi subnitras) and carbonate are 
the drugs chiefly used for this purpose. Bismuth blackens 
the stools and has also a sedative action on the stomach 
in case of vomiting. It is insoluble in water and is 
usually given dry on the tongue, followed by a drink of 
water. When giving it to infants and small children it 
is usually suspended in some fluid medicine or given in 
milk. 

Alum (i alumen ) is used locally as an astringent by injec¬ 
tion into the rectum and colon. It forms a precipitate 
with a great many drugs, and is usually given alone or 
dissolved in water. In too large doses it is a poison pro¬ 
ducing inflammation of the gastro-intestinal tract and 
death. Alum solutions for enemata should be measured 
with care. Even a mildly strong solution will sometimes 
act as a powerful irritant to the intestinal tract, and cause 
intense pain and griping. 


302 therapeutics and materia medica 

Tannic acid (acidum tannicum) is a powerful astringent 
which contracts tissue, impairs digestion, and checks 
bowel discharges. It is used internally in pill or powder 
form, and locally to the rectum and colon by enema. 
It is contained in witch hazel and many other astringent 
remedies, and is frequently used to harden the skin on 
parts of the body where much friction occurs. 

Silver nitrate (argenti nitras) is used as an astringent 
either in pill form or solution by enema. It is used in 
typhoid fever to some extent, in chronic dysentery, and 
chronic inflammation of the colon. It is easily decom¬ 
posed, and its value in pill form is questioned because of 
the changes effected in it by the stomach contents. 

Solutions should be freshly made with distilled water. 
Any animal or vegetable substance entering into the 
solution tends to decomposition. It should be kept in 
a dark place. Only glass stoppers should be used for 
bottles. 

Opium is used to a considerable extent as an intestinal 
astringent and is frequently employed in combination 
with other drugs, such as lead acetate or camphor, in 
checking diarrhea or dysentery. 

Tincture of opium (i tinctura opii) or laudanum is given 
internally in doses of from 5 to 20 minims. A somewhat 
larger dose is sometimes given by enema, but it needs to 
be used with great caution, and the symptoms of over¬ 
dosing or poisoning should be well known. 

Laudanum is frequently given by enemata, a thin solu¬ 
tion of common laundry starch being used as a vehicle. 
About 3 ounces of starch is sufficient, and if given for 
diarrhea, the solution should be almost cold. 

Camphorated tincture of opium (tinctura opii camphor - 
ata), or paregoric, contains, beside powdered opium, 
benzoic acid, camphor, glycerin, alcohol, etc. The dose 
for an infant is from 1 to 15 drops, depending on the age 
and condition of the child. Children, as a rule, do not 
bear opium well. 


EMETICS, DIURETICS, AND DIAPHORETICS 303 


CHAPTER XXXII 

EMETICS, DIURETICS, AND DIAPHORETICS 
EMETICS 

Emetics are agents that cause vomiting. They are 
used to quickly remove food or drugs causing irritation 
in the stomach; to expel an excess of bile from the gall¬ 
bladder; and to facilitate the expulsion of excessive secre¬ 
tion or false membranes obstructing the air-passages. 

Emetics are of two classes—those having a local and a 
systemic action. 

Emetics Having Local Action. —Common examples of 
the first class are tepid water in quantity (2 to 4 glasses) ; 
salt solution; mustard and water; powdered alum; putting 
the finger down the throat. 

Salt (sodium chlorid) solution may be given warm, 
using as much salt as the water will dissolve. 

Alum (alumeri) may be given in i-teaspoonful doses 
for a child and a teaspoonful for an adult. Mix well 
with honey or syrup. 

Mustard is given in doses of from J to 1 teaspoonful 
for a child and double the quantity for an adult, stirred 
in a glass of warm water, and quickly swallowed. It 
may be followed with copious drinking of tepid water. 

Emetics Having Systemic Action. —Common ex¬ 
amples of emetics having a systemic action are ipecac 
and apomorphin. These have a certain local action also, 
producing an irritation of the nerves of the stomach, as 
well as of the vomiting center. Opium and many other 
drugs produce vomiting as an after-effect. 

Syrup of ipecac (syrupus ipecacuanhas) is a favorite 
remedy in cases of croup and capillary bronchitis in 
children. A teaspoonful of the syrup may be given and 
repeated in fifteen minutes. It is slow in action, but is 
considered a safe, non-depressant remedy. 

Apomorphin acts rapidly and directly on the vomiting 


304 


THERAPEUTICS AND MATERIA MEDICA 


center. It is a powerful heart and respiratory depressant 
in large doses. Is usually given hypodermically. The 
dose varies from -n> t° A grain. 

DIURETICS 

Diuretics are remedies which increase the secretion of 
the urine. They are used: 

1. To dilute the urine. 

2. To stimulate the kidneys. 

3. To promote the elimination of waste matter and 
poisonous substances from the body. 

4. To carry out of the body the excess of fluid in diop- 

sical conditions. 

Water is regarded as the best of all diluents for the 
urine. Many mineral waters are prescribed for this pur¬ 
pose, not because of the mineral constituents, but in order 
to induce the patient to drink enough water to thoroughly 
flush out the system. 

When the urine is highly acid, some benefit may be 
secured from the use of alkaline mineral waters, such as 
Vichy. 

Potassium bitartrate (potassii bitartras), or cream of 
tartar, is classed as a refrigerant diuretic. It is most 
effective when given well diluted with water. A favorite 
old-fashioned method of giving it was in the form of cream- 
of-tartar lemonade. 

The prescribed amount of the drug was dissolved in hot 
water. When cold, the clear solution was poured off, and 
sliced lemons and lemon-juice were added with sugar, to 
make it a palatable drink. The patient was directed .to 
drink freely of it. This is popularly known as “Imperial 
Drink.” 

Potassium citrate (potassii extras) is an alkaline 
remedy much used as a diuretic. It is a deliquescent 
drug, and may liquefy by absorption of moisture from 
the atmosphere. It is given largely diluted with water. 

Digitalis acts as a diuretic through its action on the 
general and renal circulation. It is said to contract the 


EMETICS, DIURETICS, AND DIAPHORETICS 305 

blood-vessels of the body and to dilate the arteries of the 
kidneys, thus increasing the blood-pressure; is frequently 
used in congestion of the kidneys and cardiac dropsy. 

It is irritant to the stomach and bowels, has a cumu¬ 
lative action, and slows the pulse. It is sometimes used 
in the form of a poultice applied over the kidneys—hot 
water being poured on the digitalis leaves. 

Infusion of digitalis is made from the leaves. It rapidly 
decomposes and should be freshly made in small quanti¬ 
ties. 

Digitalis has two active principles—digitalin and digi- 
toxin—which are given hypodermically in tablet form; 
dose, gr. y^o- of either. 

Other preparations of digitalis are extract of digitalis, 
given in pill form; fluidextract of digitalis; tincture of 
digitalis. 

It is important that the patient be kept absolutely lying 
down when digitalis is being given. Digitalis is an active 
vegetable poison, and deaths from overdosing have oc¬ 
curred. 

Diuretin is used as a diuretic in case of dropsical effu¬ 
sions. It is said to occasionally cause diarrhea, but does 
not appear to irritate the stomach. 

Urotropin acts as a urinary antiseptic, increases the 
amount of the solids in the urine, and the flow. Urotropin 
is the trade name for a common drug which can be more 
economically purchased under the name hexamethylena- 
mine (the Pharmacopeial name). 

Caffein has an action resembling digitalis in its effect 
on the heart, but its effect is produced more rapidly and 
is more transient. It acts as a stimulant to the kidneys. 
The citrate of caffein is a preparation that is very fre¬ 
quently used. An effervescent preparation is also made. 
It sometimes produces marked nervous symptoms, even 
after comparatively small doses. 

Fruits, fish, and milk are said to increase the alka¬ 
line reaction of urine by the salts they carry into the 
system. 

20 


I 


306 THERAPEUTICS AND MATERIA MEDICA 

DIAPHORETICS 

Diaphoretics increase the action of the skin and pro¬ 
duce perspiration. 

The first and most natural remedies for this purpose 
are heat and water. These may be secured by means 
of hot air, hot baths or packs, hot drinks, and by the free 
use of hot-water bottles, bricks or hot irons, and plenty 
of blankets. 

Heat has the effect of dilating the capillaries and stimu¬ 
lating the sweat-glands. In using hot-air or hot-water 
baths for this purpose, attention must be paid to the small¬ 
est details. What may seem a trifling carelessness may be 
sufficient to defeat the entire purpose of the treatment 
or cause very undesirable after-effects. 

In a great many hospitals there are now hot-air machines 
or boxes, in which the whole body or a limb is subjected to 
a high degree of dry heat. In some of these hot-air outfits 
the heat is produced by rows of electric-light bulbs ar¬ 
ranged in a closed cabinet. This method gives the com¬ 
bined effect of the light and heat. 

In others the limb and sometimes the whole body is 
placed in a specially constructed hot-air cylinder, the heat 
being produced by alcohol or gas. A very much higher 
degree of dry heat can be borne than of moist heat with¬ 
out burning. A special high-registering thermometer is 
used to record the temperature, which is raised very 
gradually and carefully regulated. The body or the 
part needs to be carefully and evenly wrapped or pro¬ 
tected, and anything in the form of oil or ointment should 
be removed before covering the part. Very bad burns 
have resulted from neglect of these precautions. 

No patient should be left alone during one of these 
treatments. The condition of the pulse should be closely 
watched. 

To give a hot-air hath in bed a body cradle is placed in 
the bed. The sheet is covered by a mackintosh and this 
by a blanket and the patient’s clothing is removed. The 
hot air may be secured by means of a portable coal oil 
or gas stove at the foot of the bed arid conducted by means 


EMETICS, DIURETICS, AND DIAPHORETICS 307 

of a pipe under the cradle. Over the cradle is placed a 
heavy blanket or thick quilt and a large rubber sheet. 
These are tucked snugly in all around to prevent the 
escape of air. The temperature may range from 100° 
to 150° F. in such treatments. If a steam bath is given, 
the temperature should not be allowed to exceed 112° F. 

The duration of such baths is ordered by the physician. 
From twenty minutes to one-half hour is the average time. 
The patient is encouraged to drink freely of hot drinks, 
but care should be used that the arms are not exposed. 
Cold compresses or an ice-cap are kept to the head during 
the bath. After the apparatus is removed the patient 
should be dried and wrapped in a dry blanket. Great 
care must be.used to prevent chilling after the bath. 

For patients who are not confined to bed free perspira¬ 
tion may be induced by a hot-air bath, given in a cane- 
seated chair. Prepare a hot foot-bath, having the water 
as hot as can be borne. Let the patient, with clothing 
removed, sit in the cane or open wicker chair with feet 
immersed in the hot water. Wrap several blankets 
around the chair, pinning them together at the neck and 
in several other places, and having them reach the floor. 
Burn an alcohol lamp with a large wick under the chair. 

Hot drinks of lemonade, ginger tea, or any fluid preferred 
should be administered freely during the process, and the 
patient should lie down and be allowed to cool off very 
gradually afterward. 

Hot-water baths and packs will be discussed under 
Hydrotherapy. 

Pilocarpin ( jaborandi ) is the drug principally used 
as a diaphoretic, when intense and rapid action is desired. 
The patient should be kept in bed between blankets and 
dry heat applied. 

Pilocarpin is a cardiac and respiratory depressant, and 
the pulse, respiration, and general symptoms should be 
closely observed. The dry heat partially combats the 
general depression and assists in promoting perspiration. 
The perspiration lasts from three to five hours. The secre¬ 
tion of saliva, also the nasal, bronchial, and lacrimal 


308 THERAPEUTICS AND MATERIA MEDICA 

secretions are increased. The temperature may be ex¬ 
pected to fall from one to four degrees. The depressing 
effects usually subside in from three to six hours. 

Pilocarpin hydrochlorid is prepared in tablet form for 
hypodermic use. The drug is also used as a fluidextract. 

Sweet spirits of niter ( tpiritus cetheris nitrosi) is given 
both for its diuretic and diaphoretic effect. When given 
to increase the flow of urine, the patient should be kept 
cool and the drug given in iced or very cold water. When 
given to induce perspiration, it should be preceded by 
hot drinks and the patient kept warmly covered. It 
should be given well diluted with water. It evaporates 
rapidly if not well corked and deteriorates with age. Old 
solutions should not be used. It is used to a considerable 
extent in expectorant mixtures and to allay feverishness 
in children. __ 


CHAPTER XXXIII 
CARDIAC STIMULANTS AND SEDATIVES 

Stimulant is a term which is used in a variety of ways 
in reference to remedial agents. Its original meaning 
was a goad, a whip, or lash, used to incite some organ to 
greater activity. 

Diffusable stimulants have a prompt but transient effect 
on the general functions of the body. To this class belong 
ammonia, camphor, various smelling salts, and alcohol. 

Respiratory stimulants act directly on the nerve centers 
controlling respiration. Examples—strychnin, ammonia, 
and belladonna. 

Vasomotor stimulants act on the blood-vessels. Ex¬ 
amples— nitroglycerin, ether, alcohol, strychnin, digitalis, 
electricity, and adrenalin. 

Cerebral stimulants act on the cerebrum. Examples 
alcohol, opium, caffein, tea, etc. 

Gastric stimulants act on the stomach. Examples 
nux vomica, ginger, capsicum, and the vegetable bitters. 

Cutaneous stimulants act on the skin and superficial 



CAEDIAC STIMULANTS AND SEDATIVES 309 

vessels and include diaphoretic agents and rubefacients. 
Examples—turpentine and mustard. 

There is no other class of drugs which a nurse will need 
to use so frequently in emergency, or the use of which 
will be left so often to be determined by her judgment, 
as cardiac stimulants, those which act directly on the 
heart and organs of circulation. No class of drugs is 
used so promiscuously by the laity unless it be pain-re¬ 
lieving drugs, another exceedingly important group. An 
English physician (Herbert E. Cuff), in commenting on 
this condition in a lecture to nurses, says: “In the minds 
of non-professional people lies deeply rooted the idea 
that everything which helps ‘to keep the patient up’ 
must be good for him. The result is that sometimes 
a patient is so effectually kept up that he disappears 
altogether from th$ scene. A patient does not need stim¬ 
ulants because he is going to have a hard fight to pull 
through. Giving alcohol to a patient merely because 
he is suffering from a severe illness comes to much the 
same thing as beating a horse because it has a heavy load 
to carry. So long as heart and horse are doing their work 
satisfactorily, we let well enough alone. When they show 
signs of tiring, then is the time for stimulating them.” 

Indications for Stimulants. —The term “indication” 
in reference to remedial agents means the evident demand 
of the system for a certain remedy. 

1. Shock .—Mental impressions, fright, etc., or severe 
pain may cause faintness and general weakness of all the 
vital functions. Surgical shock, accidents, loss of blood, 
etc., cause general relaxation, almost paralysis, of the 
nervous and muscular system. 

2. Exhaustion of the heart, shown by weak, rapidly 
increasing pulse. 

3. In cases of profound toxemia with an exhausted ner¬ 
vous system, shown by low muttering delirium, tremor, etc. 

4. In cases of extreme debility when all the functions 
seem to need quickening. 

Effects of stimulants widely differ. Most of them are 
violent poisons when taken in too large doses. The heart 


310 


THERAPEUTICS AND MATERIA MEDICA 


is irritated and made to work harder by many stimulants, 
but it is not strengthened. The pulse is strengthened 
because a greater volume of blood is forced into the arteries. 
A whip does not strengthen a horse. If it did, he might 
be fed on whips. It helps to incite him to keep going till 
a certain point is reached. Too much whipping or too 
much stimulation may produce a collapse of a horse or of 
the heart. Many stimulants, if too long continued or 
used in too large doses, cause a poisoning of the nervous 
system. 

" Rest. —In all conditions requiring stimulation of the 
heart, rest is an important factor. Everything that 
might add to the strain the organ is already laboring under 
should be avoided. 

Heat acts as a general stimulant to the vital functions. 
The heating of the blood in the superficial tissues of the 
body increases the action of both heart and lungs. Cold¬ 
ness of the surface of the body is one of the important 
signs of depression of the vital organs. In case of active 
hemorrhage, heat is contra-indicated. 

Elevation of the foot of the bed increases the supply 
of blood to the brain, and helps to keep that important 
organ in condition to do its work. It also helps the heart 
to force the blood to the vital organs. Bandaging of the 
legs is also resorted to for similar reasons. 

Salt solutions by rectum, hypodermoclysis, or intra¬ 
venous infusion increase the volume of blood. In many 
cases requiring stimulation there is too little blood in 
proportion to the wide channels in which it must circulate. 

General effects of salt solutions are said to be: 

1. Stimulation of the heart, 

2. The red blood-corpuscles undergo regeneration. 

3. Arterial tension is increased. 

4. Toxic substances in the blood are diluted and their 
elimination hastened. Usually the kidneys share in the 
stimulation and more urine is voided. 

5. The fluids of the body are increased and the general 
condition of the patient improved. 

Tea and coffee contain the alkaloids thein and caffein, 


CARDIAC STIMULANTS AND SEDATIVES 


311 


which are said to be identical. The warmth of the infusion 
adds to the stimulating effect, while the water used in 
making the infusion adds to the fluids of the body. In 
certain forms of mental torpor due to toxemia these are 
useful, their action being chiefly on the nervous system. 
Green tea possesses more active properties than black. 

Meat Extracts. —A great many extracts and essences 
are said to have a stimulating effect. Thompson, in 
Practical Dietetics, speaking of the extract of mutton, 
says: “The extract has the advantage of keeping for 
years without decomposition, and it has been found that 
sometimes in cases of shock, especially after wounds re¬ 
ceived on the battlefield, its stimulant action has been 
considered almost equal to that of alcohol, and, bulk for 
bulk, it is certainly greater.” 

Strychnin is the alkaloid of nux vomica. It acts as a 
stimulant to the heart, respiratory, nervous, and muscular 
systems, and increases the tone of the blood-vessels. In 
small doses it acts as a general tonic. It accumulates in 
the system and may cause unpleasant effects after the 
repetition of even small doses. The cumulative action 
is especially to be feared when taken in pill form. Symp¬ 
toms of muscular twitching, stiffness of the jaw with gen¬ 
eral restlessness, and jerking of the limbs are among the 
symptoms of overdosing. 

Dose of strychnin sulphate (strychnines sulphas), gr. -g-V 
to -jV* 

Dose of tincture of nux vomica (nucis vormcce), 4 to 20 
minims. 

Dose of fluidextract of nux vomica, \ to 2 minims. 

Dose of extract of nux vomica, \ to \ grain. 

Nitroglycerin (glonoin) resembles amyl nitrate in its 
effects. It acts less rapidly, but the effects last longer. 
It dilates the blood-vessels and lowers the blood-pressure. 
Usually its effects pass off in less than one hour. In large 
doses the respiration and body temperature are lowered. 
The face is flushed, the pulse quickened, and there is more 
or less headache and vertigo. It is usually given when 


312 THERAPEUTICS AND MATERIA MEDICA 

the arterial tension is above normal. The tablet form is 
most frequently used. A 1 per cent, alcoholic solution 

is also made. Dose, gr. -5-ro to to* 

Adrenalin chlorid acts by raising the blood-pressure, 
and is one of the most powerful hemostatics and astrin¬ 
gents known. It is used mainly for hypodermic medica¬ 
tion, usually in a 1: 1000 solution. The dose of the 
solution varies from 5 to 30 minims. 

Strophanthus acts by contracting muscular tissue. 
On the heart it stimulates the contractions, decreases the 
rate of heart-beats, and raises the blood-pressure. It 
resembles digitalis in action, but does not accumulate in 
the system. 

Dose of tincture of strophanthus (Tindura strophanthi ), 
5 to 20 minims. 

Strophanthin (tablet) for hypodermic use, gr. nnr to 

°Spartein sulphate acts rapidly, increases the force and 
rapidity of the pulse, raises the arterial tension, and de¬ 
presses the nervous system. Dose, gr. 2 V to 1. 

Digitalis stimulates the heart, regulates its rhythm, 
slows the pulse, and increases its force; has also a diuretic- 
action and accumulates in the system. Signs of over¬ 
dosing: a slow, full pulse (it may fall to 40 beats a minute); 
vomiting; pain in the head; disturbed vision. 

Ammonia is adiffusable stimulant, having a rapid fleet¬ 
ing action on the heart and respiration. Carbonate of 
ammonia is an ingredient of many kinds of smelling salts, 
and is given by cautious inhalation in fainting. 

Aromatic spirits of ammonia contains, besides am¬ 
monia, oils of lemon, lavender, and nutmeg, alcohol, 
and water. It is used internally in doses of from J to 
1 dram, diluted with water. It acts as a general stimu¬ 
lant. 

Caffein citrat (<caffeina citras) is contained in coffee. 
It quickens the heart action, raises the blood-pressure, 
and stimulates the brain. It also increases the respira¬ 
tion and has a diuretic action. Dose, gr. ^ to 2. 


CARDIAC STIMULANTS AND SEDATIVES 


313 


Alcohol in small doses increases the action of the heart, 
dilates the blood-vessels of the skin, increases perspira¬ 
tion, and at first stimulates the brain. In larger doses 
the cerebral excitement becomes disorderly, and there is 
lack of coordination of muscular movement with inco¬ 
herent, rambling ideas from overstimulation of the brain- 
cells. In excessive doses the brain suspends its functions 
and there is complete unconsciousness. The whole system 
is intoxicated or poisoned. 

Alcohol is said to diminish the waste of tissue in acute 
diseases where there is fever. It is not a food, as many 
people seem to believe, that is, it does not repair the waste 
of the tissues. It is said to be consumed by the oxygen 
contained in the tissues during fever, and in that way 
lessens waste, but there is grave danger of giving too 
much under these conditions. It is said by experienced 
physicians that many patients in a delirious or semi- 
delirious condition are made worse by too much alcohol, 
and nurses should exercise particular care to give only 
the amount ordered. Very frequently the patient’s 
friends regard it as a sheet-anchor or a kind of “cure-all,” 
and believe that if a little is good for the patient, more 
will be better. Alcohol is a drug which in improper quan¬ 
tities becomes a poison. That fact should never be for¬ 
gotten. Unless in case of dire emergency it should never 
be given by a nurse without a physician’s orders. The 
general rule observed by physicians is to order it to be 
given in small doses. As the effects pass off compara¬ 
tively quickly and there always follows a reaction, when 
all the vital powers are depressed, it must be repeated 
frequently in cases of continued illness where it seems to 
be demanded. Whisky and brandy are given in water, 
about two parts of water to one of the drug. 

Effects of Alcohol .—Herbert E. Cuff 1 gives the following 
signs by which a nurse may know whether it is doing good 
or having the reverse effect upon the patient: 

“Broadly speaking, it is doing good if it tends to bring 
the patient nearer to his normal condition. Thus: 

1 “ Lectures on Medicine to Nurses.” 


314 


THERAPEUTICS AND MATERIA MEDICA 


“ 1. If it slows and strengthens the too quick pulse 
or quickens the abnormally slow pulse. 2. If it slows the 
hurried respiration. 3. If it moistens the dry tongue. 
4. If it cools and moistens the hot, dry skin. 5. If it 
lessens delirium and induces sleep, it is doing good and 
may be continued. 

“ If it has the contrary effect, and seems to add to in¬ 
stead of diminishing the above five conditions, it is 
harmful. ” 

Preparations of Alcohol. —Alcohol is obtained by the 
distillation of fermented saccharine fluids, and is con¬ 
tained in all liquors, also in tinctures, spirits, and some 
liniments. 

Diluted alcohol is composed of about 41 per cent, of abso¬ 
lute alcohol (by weight) and about 59 per cent, of water. 

Whisky is obtained by distilling fermented grain—rye, 
wheat, or corn. It usually contains 44 to 50 per cent, of 
alcohol. 

Brandy is a product of the fermented juice of the grape 
four years old. Coloring substances are used to color the 
darker preparations. It is often prepared by artificial 
means, various chemical combinations being used. It 
contains 39 to 47 per cent, of alcohol. 

White mine is made by fermenting the juice of the grape, 
free from skins, seeds, and stems. It should contain 10 
to 14 per cent, of alcohol. 

Red mine has the same alcoholic strength. It is colored 
by using darker grapes and their skins. 

Port wine has alcohol added during process of manu¬ 
facture. It contains 30 to 40 per cent, of alcohol. 

Sherry wine contains 20 to 35 per cent, of alcohol. 

Champagne contains 8 to 10 per cent, of alcohol. 

Claret contains tannic acid and coloring-matter and 
should have 5 to 7 per cent, of alcohol. 

Beer, ale, and porter are made from malted grain, with 
hops and other bitters added. Their alcoholic strength 
varies from 2 to 6 per cent. 


CARDIAC STIMULANTS AND SEDATIVES 


315 


PHYSIOLOGIC EFFECTS OF FOOD AND ALCOHOL 1 

In discussing the physiologic effect of alcohol, Dr. Hall 
makes use of what he regards as the “deadly parallel” 
between food and alcohol: 


FOOD 

“1. A certain quantity will produce 
a certain effect at first, and the same 
quantity will always produce the same 
effect in the healthy body. 

“2. The habitual use of food never 
induces an uncontrollable desire for it 
in ever-increasing amounts. 

“3. After its habitual use, a sudden 
total abstinence never causes any de¬ 
rangement of the central nervous sys¬ 
tem. 

“4. Foods are oxidized slowly in the 
body. 

“5. Foods, being useful, are stored in 
the body. 

“6. Foods are the products of con¬ 
structive activity of protoplasm in the 
presence of abundant oxygen. 

“7. Foods (except meats) are formed 
in nature for nourishment of living or¬ 
ganisms, and are, therefore, inherently 
wholesome. 

“8. The regular ingestion of food is 
beneficial to the healthy body, but may 
be deleterious to the sick. 

“9. The use of food is followed by 
no reaction. 

“10. The use of food is followed by an 
increased activity of the muscle-cells 
and brain-cells. 

“11. The use of food is followed by an 
increase in the excretion of CO 2 . 

“12. The use of food may be followed 
by accumulation of fat, notwithstanding 
increased activity. 

“13. The use of food is followed by a 
rise in body temperature. 

“14. The use of food strengthens and 
steadies the muscles. 

“15. The use of food makes the brain 
more active and accurate. 


ALCOHOL 

“1. A certain quantity will produce a 
certain effect at first, but it requires 
more and more to produce the same 
effect when the drug is used habitually. 

“2. When used habitually it is likely 
to induce an uncontrollable desire for 
more, in ever-increasing amounts. 

“3. After its habitual use, a sudden 
total abstinence is likely to cause a seri¬ 
ous derangement of the central nervous 
system. 

“4. Alcohol is oxidized rapidly in the 
body. 

“4. Alcohol, not being useful, is not 
stored in the body. 

“6. Alcohol is a product of decompo¬ 
sition of food in the presence of a scar¬ 
city of oxygen. 

“7. Alcohol is formed in nature only 
as an excretion. It is, therefore, in 
common with all excretions, inherently 
poisonous. 

“8. The regular ingestion of alcohol 
is deleterious to the healthy body, but 
may be beneficial to the sick (through 
its drug action). 

“9. The use of alcohol, in common 
with narcotics in general, is followed by 
a reaction. 

“10. The use of alcohol is followed by 
a decrease in the activity of the muscle- 
cells and brain-cells. 

“11. The use of alcohol is followed by 
a decrease in the excretion of CO 2 . 

“12. The use of alcohol is usually fol¬ 
lowed by an accumulation of fat through 
decreased activity. 

“13. The use of alcohol may be fol¬ 
lowed by a fall in body temperature. 

“14. The use of alcohol weakens and 
unsteadies the muscles. 

“15. The use of alcohol makes the 
brain less active and accurate.” 


CARDIAC SEDATIVES 

A great many drugs, especially those used as nerve 
sedatives and antipyretics, exercise a depressing action 
on the heart, rendering great caution necessary in their 

^rom “Text-book of Hygiene,” by George H. Rohe, M. D., and 
Albert Robin, M. D. 


316 


THERAPEUTICS AND MATERIA MEDICA 


use. When it becomes necessary to depress the heart and 
general circulation, aconite and veratrum viride are fre¬ 
quently used for that purpose. 

Aconite ( aconitum ) acts as a powerful depressant to 
the heart, respiration, and, to some extent, to the nervous 
system. It is also antipyretic, diaphoretic, and diuretic. 
The tincture is the preparation most frequently used. 
Dose of the tincture, 1 to 4 minims; of the fluidextract, 
1 to 2 minims. Signs of overdosing are tingling sensation, 
weak, irregular, slow pulse, shallow respiration. 

Veratrum viride is occasionally given in cases of con¬ 
vulsions, acute mama, aneurism, and cerebral inflamma¬ 
tion. It reduces the force of the pulse, but at first does 
not affect its rapidity. If continued, the pulse becomes 
verv slow and compressible, the least exertion markedly 
quickening it. In large doses there is decided muscular 
weakness and nausea, the skin becomes cold and clamm) T , 
there is also hiccough, dizziness, or partial unconscious¬ 
ness. Death may result from paralysis of the heart. 
The patient should be kept absolutely lying down. If 
the pulse falls much below 60 while giving veratrum it 
should be considered a danger signal. It is usually given 
in tincture form, 1 drop being given and repeated at in¬ 
tervals till the desired effect is produced. Maximum dose 
of the tincture, 20 minims; of the fluidextract, 3 minims. 


REMEDIES IMPROVING DIGESTION AND NUTRITION 317 


CHAPTER XXXIV 

REMEDIES WHICH IMPROVE DIGESTION AND 
NUTRITION 

The nutrition of the body is dependent on good diges¬ 
tion and good assimilation of the food that is provided. 
Drugs are useful in certain conditions, but the tendency 
of the laity is to depend altogether too much on drugs 
to improve digestion. If debilitated or diseased tissue 
is to be replaced by normal healthy tissue in the body, 
if strength and energy are to be restored, the patient 
must desire natural food and take and assimilate it in 
sufficient quantity, since food, and food only, can fur¬ 
nish to the blood the substances which the cells of the 
body need for building up and restoring normal conditions. 
Hence, it is of first importance that the food be wisely 
chosen and properly prepared. 

Tonics are defined as agents which improve the general 
health of the body. The term would include a large group 
of drugs, including many stimulants already mentioned. 
The most typical tonics are strychnin, quinin, iron, and 
the vegetable bitters. Iron, manganese, cod-liver oil, 
and other fats are given to increase the red corpuscles 
of the blood. 

Natural tonics would include fresh air, moderate ex¬ 
ercise, sunshine, pleasant associations and surroundings, 
dainty serving of food, and'attractive cookery. A brisk 
walk in the open air, especially cold air, acts as a natural 
stimulant to the appetite. 

Sunshine is as essential to the health of human beings 
as to plants. It may not be possible to explain the mys¬ 
terious process by which the sun affects the general con¬ 
dition of the system, but it is well known that it does so. 

Mental Influence .—The mind influences the body in a 
subtle, mysterious way, and pleasant association and 
wholesome mental influence are in themselves efficient 
tonics. 


318 THERAPEUTICS AND MATERIA MEDICA 

Attractive cookery and serving of food are powerful factors 
in creating both an appetite for food and in preparing the 
digestive organs to deal with it. It has been proved by 
physiologic experiment 1 that “ there are two tides of gastric 
juice secretion. The first, ‘appetite juice/ is induced by 
hunger and the pleasurable sight or smell of food, or the 
sounds associated with its preparation, and is psychic. 
This secretion is abundant and actively digestant. The 
second is excited by the mechanical and chemical action 
of food in the stomach. Of the two, the former often 
proves the more important, for food which is unappetiz¬ 
ing or food which for any reason is eaten without relish, 
or while the mind is strained in the other channels, may 
remain for hours undigested.” 

“ Appetite may be depressed or destroyed by mental 
emotion, especially grief, anxiety, and worry; by the sight, 
smell, or taste of ill-prepared or improperly cooked or 
badly served food; foul air and poor hygienic surroundings; 
diseases and most gastric disorders; nausea; the abuse 
of strong condiments, and of many drugs, notably opium, 
and those which, like potassium iodid, produce a continual 
offensive taste in the mouth; the abuse of alcohol; eating 
irregularly and at too short intervals.” 

It does not require an intricate physiologic experi 
ment to teach a nurse that artistic cookery and food sei v- 
ing stimulate the digestive juices. She has probably ex¬ 
perienced the sensation of having her “mouth water” at 
the sight of some tempting food or when a pleasant odor 
of cookery was wafted to her. In other words, the nerves 
of sight and smell stimulated the salivary glands, so that 
there was a greater flow of saliva ready to act on the food 
as soon as it entered the mouth. The nerves of sight, 
smell, and taste exert a similar action on the nerves of 
the stomach, causing a greater flow of gastric juice. 

Mental Emotion. —A well-known medical writer has 
stated that the expression “laugh and grow fat” is cer¬ 
tainly not without a physiologic basis. It is well known 
1 Practical Dietetics, Thompson. 


REMEDIES IMPROVING DIGESTION AND NUTRITION 319 

that pleasurable emotions aid digestion, and that fright, 
terror, or excessive nervous excitement hinder it; also 
that if anxiety or worry be prolonged, digestion is invari¬ 
ably impaired, even though the appetite may remain 
apparently normal. 

Pepsin ( ; pepsinum ) is the most widely used of all the 
artificial digestive preparations. It is obtained from the 
inner coat of the stomach of the pig. It has the power 
of converting albuminoids (casein, albumin, etc.) into 
peptones, with the aid of hydrochloric and lactic acids. 
It always requires an acid reaction to do its work, and 
should never be given in combination with soda bicarbon¬ 
ate or any alkali, unless so ordered. Occasionally, when 
too much hydrochloric acid and too little pepsin is the 
digestive difficulty, soda bicarbonate may be given to 
neutralize the excess of the acid. It is believed by many 
authorities that pepsin is of much less importance in 
gastric disorders than hydrochloric acid, and that except 
in cases of hyperacidity of the stomach they should be 
used together. 

Hydrochloric acid (azidum hydrochloricum) is formed 
by combining common salt with sulphuric acid. It is 
always given diluted. The dose of the diluted hydro¬ 
chloric acid is from 5 to 10 drops. 

Pancreatin ( pancreatinum ) is a digestive ferment 
usually obtained from the fresh pancreas of the pig or 
calf. It digests albuminoids and emulsifies fats, and is 
said to be more serviceable for the predigestion of food 
than any of the other ferments. It is usually given with 
soda bicarbonate, as it requires an alkaline solution to do 
its work. It is said that most of the so-called “pepton¬ 
ized foods ’’ are made with pancreatin instead of pepsin. 
It is used both in powder form and in solution. Groff 
gives the following formula for preparing a fresh solution: 

“ It may be prepared by soaking the cleaned and chopped 
fresh pancreas of the pig in diluted alcohol for twenty- 
four hours; pouring off the alcohol; adding ten times its 
weight of glycerin, and, after twenty-four hours of stand- 


320 


THERAPEUTICS AND MATERIA MEDICA 


ing, pouring off and straining the liquid. This may be used 
in the place of the commercial powder and is always 
effectual, while the latter, through ignorance in making 
or carelessness in keeping, may be quite worthless. 
When glycerin is combined it should not be used for pre¬ 
paring foods for nutrient enemata. 

All peptonized or pancreatinized foods are said by 
Thompson to be open to the objection that they are much 
more expensive, if used for long at a time, than the prep¬ 
arations which can be easily made at the bedside by any 
intelligent person by the use of simple pancreatin ex- 
tracts 

Diastase is a vegetable ferment that converts starch 
into grape-sugar or glucose. 

Taka-diastase is a powerful starch digestant used in 
small doses in certain forms of dyspepsia. 

Rennet (; rennin ) is obtained from the stomach of the 
calf. It has special milk-curdling properties and is the 
chief ingredient of the so-called junket tablets. 

Caroid is another vegetable ferment useful in softening 
meat fibers. It coagulates milk similar to rennet and 
dissolves gastric mucus. It is similar in action to papoid 
or papain, both being obtained from the pawpaw tree in 
South America. 

Constitutional Tonics—Iron ( ferrum ), in all its 

numerous forms and preparations, is obtained from the 
metal. It is found in the blood and is contained in vari¬ 
ous foods, notably beef. In small doses it increases the 
appetite and improves digestion. In large doses or long- 
continued small doses it is liable to produce nausea, indi¬ 
gestion, and constipation. It has an astringent action 
and darkens the stools, has also an irritant effect, and acts 
injuriously on the teeth. 

Tincture of chlorid of iron (tinctura ferri chloridi) is 
said to be one of the best preparations for internal use. 
In giving all preparations of iron, constipation must be 
guarded against by some form of laxative. 

Cod-liver oil ( oleum morrhuce) is obtained from the 


NERVE SEDATIVES AND ANTIPYRETICS 


321 


liver of the common codfish. It contains iodin, phos¬ 
phorus, and other important mineral ingredients. In the 
body it produces heat and energy; is exceedingly nause¬ 
ous to the taste, though there are preparations from which 
the disagreeable taste and odor have been largely removed. 
These are usually less valuable in medicinal qualities than 
the common oils. The directions given for taking castor 
oil may be used to disguise the disagreeable taste. 

Vegetable Bitters.—Gentian ( gentiana ) is a simple 
bitter tonic that has held its place as a valuable medicine 
from early historic times. 

Cinchona bark preparations are similar in action to gen¬ 
tian as a bitter tonic. 

Quinin (<quinince sulphas) is one of the four alkaloids 
of cinchona. In small doses it acts as a bitter tonic and 
slightly stimulates respiration. In larger doses it has a 
depressing effect on the heart and circulation, causes ring¬ 
ing in the ears, dizziness, and headache. It acts as an 
antipyretic in malarial fever, and is used both for pre¬ 
ventive and curative effect. 


CHAPTER XXXV 

NERVE SEDATIVES AND ANTIPYRETICS 

Sedatives are defined as remedies which diminish the 
activity of the tissues of the body. Nerve sedatives act 
particularly on the brain and nervous system. Many 
drugs produce sleep, but do not relieve pain. 

Some of the drugs which relieve pain also reduce fever. 
All of these drugs act more or less disastrously on the tissues 
of the body. The immediate bad effects from their use may 
not be readily apparent, but it should always be remem¬ 
bered that while such drugs may be necessary under certain 
conditions, they do produce injurious effects on some of 
the tissues and should never be used unnecessarily. They 
21 



322 


THERAPEUTICS AND MATERIA MEDICA 

are emergency remedies, useful to tide over a certain point 
in disease, but to be discontinued as soon as the emerg¬ 
ency is passed. Because the nurse is so often left to 
decide whether or not a sleep-producing drug is really 
necessary, special study should be given to this group o 
drugs and their effects, and also to the simple substitutes, 
which sometimes can be used instead of drugs of this class. 

Outdoor Air.—One of the facts which has received 
abundant demonstration is that the atmosphere has both 
tonic and sedative properties. A condition of delicious 
drowsiness and disposition to sleep a great deal more than 
usual is one of the common experiences of invalids who 
have adopted tent life for a time. Therefore, among the 
very first sedatives should be placed plenty of fresh air. 
One great reason for sleeplessness in many cases is that 
the room is too warm, leaving out of the question the fre¬ 
quent impurity of the air. In steam-heated houses and 
apartments this is a very common condition unless the 
heat and ventilation are carefully regulated. 

Water.—The sedative effects of cold, tepid, or neutral 
baths or packs are recognized by all medical authorities. 
It has happened not infrequently that a nervous patient 
who has resisted the influence of moderate doses of power¬ 
ful drugs used to induce sleep, has quickly fallen asleep 
after the application of a tepid pack or bath. In quieting 
the delirium of fever and the excitability of certain 
classes of insane 'patients, the effectiveness of this form 
of treatment are every day being demonstrated. 

Warmth.—Cold air for the lungs is conducive to sleep, 
but the patient should be warmly clad, so that no part of 
the body becomes chilled, if sleep is desire<J. Cold feet 
and general chilliness are quite sufficient to produce wake- 
fulness without any other cause. It is better to have the 
feet thoroughly warm and the bed warm before sleep is 
desired, than to depend on applying artificial heat to the 
feet at the time. The mere presence in the bed of a hot- 
water bottle, 10 or 12 degrees above body heat, is suf¬ 
ficient to keep a sensitive, nervous patient awake. 


NERVE SEDATIVES AND ANTIPYRETICS 323 

Removal of Physical Discomfort.— This would in¬ 
clude straightening out wrinkles in the sheets or clothing, 
brushing out crumbs, shaking and turning pillows, bathing 
face and hands, etc., all of which should be done and the 
patient made as comfortable as possible before turning 
out the lights. 

Darkness is quite as necessary for human beings as for 
plants, and Nature’s plan is to have darkness as the time 
for rest. Few individuals can expect to sleep soundly 
and restfully unless quietness and darkness are produced. 
Noise and light are directly antagonistic to sleep. 

Mental excitement, as far as possible, should be 
guarded against for three or four hours before bedtime in 
the case of wakeful invalids. This would possibly require 
the prohibition of reading, animated discussion of any 
subject, visitors, concentrated thought, or anything that 
might tend to cerebral excitement or activity. It is cer¬ 
tainly foolish to cause the brain to be excited or stimu¬ 
lated by these means, and then depend on drugs to 
counteract the excitement. 

Food. —As a general rule, it is a mistake to give a full 
meal just before bedtime, but it is also a mistake to ex¬ 
pect a patient to go to sleep promptly with the stomach 
entirely empty. A cup of thin gruel or hot milk sipped 
slowly, with a few crackers, at bedtime act as a hypnotic 
with a great many patients, and these measures leave 
no injurious effects. Tea or coffee should not be used for 
the evening meal when there is a tendency to sleepless¬ 
ness. 

Rubbing also tends to quiet the nerves, and may be 
employed to.good advantage. In many cases gentle rub¬ 
bing up and down the spine may wisely be given for 
some time after the body has been rubbed. 

Reading aloud some story or selection that has no 
special plot and that is not of special interest to the patient, 
has also proved useful in chronic nervous patients afflicted 
with insomnia. Poetry is especially recommended for 
this kind of reading. No special elocutionary powers are 


324 


THERAPEUTICS AND MATERIA MEDICA 


necessary or desirable. Monotonous reading is much 
more likely to produce the desired effect. 

Chloral hydrate (chloralum hydratum) and other chloral 
preparations act as hypnotics, producing sleep, but not 
relieving pain except in dangerous doses. Chloral de¬ 
presses the nerve centers and heart muscles and lowers 
arterial tension. Occasionally chloral produces very 
undesirable effects, such as headache. On the brain it 
produces a stupor resembling natural sleep. Prolonged 
use leads to habit, and the chloral habit soon acts disas¬ 
trously on the whole constitution, producing a condition 
of marked anemia and muscular weakness. It is said 
that many cases of insanity have their origin in the chloral 
habit. Potter gives gr. xv as an average dose for a healthy 
adult; for a child, gr. j for each year of age up to gr. vj. 
It is given dissolved in water or syrup. 

Hyoscine hydrobromate (hyoscince hydrobromas) acts 
on the spinal cord and brain, and in large doses acts 
as a powerful respiratory depressant. Prolonged use 
deranges the mental faculties. Both it and chloral are 
used as hypnotics in cases of acute mania, delirium 
tremens, and other cases of intense mental excitement. 

Dose, gr. yfor to sir- , ,, . 

Sulphonal was at first believed to produce sound restlui 
sleep without any injurious effects. A prominent medi¬ 
cal authority has stated after some years of experience and 
observation that “if it were not for the very evident ad¬ 
vantage of sulphonal, when used with care and under medi¬ 
cal supervision, it would probably either be excluded from 
practice or its sale restricted by legislative authority.’" It 
acts directly on the brain cells and red blood-corpuscles. 
Prolonged use causes ringing in the ears, dizziness, weak¬ 
ness, and inability for mental or physical effort. It has a 
marked destructive action on the red blood-corpuscles. 
It is usually given in hot milk or other hot fluid about two 
hours before it is desired to produce sleep. Dose, gr. x to 

XXX. 

Trional is very similar in its composition to sulphonal. 


NERVE SEDATIVES AND ANTIPYRETICS 325 

It is said to be specially valuable in obstinate insomnia 
and in many forms of delirium. When pain is present 
it is sometimes combined with acetanilid or phenacetin. 
Dose, gr. x to xxx. 

Paraldehyd is similar in its action to chloral, but safer. 
Its effects pass off more quickly than chloral and it often 
needs to be repeated. It has a diuretic effect, slows the 
heart, and strengthens it. Prolonged use leads to habit, 
which soon wrecks the constitution. A toxic dose para¬ 
lyzes the centers controlling respiration. Potter quotes 
the average dose for an adult as 3iss. It is given in water 
or some aromatic fluid. 

Bromids. —In this group are included potassium bro- 
mid, sodium bromid, ammonium bromid, and several other 
preparations of the drug less frequently used. They 
reduce blood-pressure, slow respiration, and slow and 
weaken the heart. Bromids are preeminently depressants 
of the brain and heart. They are said by eminent author¬ 
ities to be direct nerve poisons. Sodium bromid is said to 
be the least poisonous and the most hypnotic; potassium 
bromid, the most poisonous to the heart and muscular sys¬ 
tem and the least hypnotic. Sodium bromid has been 
used to special advantage in cases of epilepsy, and all 
bromids are useful in convulsive and spasmodic affections. 
When their use is prolonged, cathartics are needed occa¬ 
sionally to prevent accumulation in the system, and arsenic 
is given to combat the acne. They should not be given 
in conditions where anemia exists, and patients using the 
drug should be under the daily supervision of a physician. 
Prolonged use deranges the mental faculties. The dose 
of potassium or sodium bromid is quoted as gr. x to xx. 
Both may be given dissolved in water. 

Opium relieves pain, produces sleep, and has a diapho¬ 
retic action. It checks all the secretions of the body ex¬ 
cept those of the skin and mammary glands, contracts 
the pupils, first stimulates and afterward depresses the 
brain, heart, and organs of respiration. It is said to 
cause unconsciousness by intoxication. Frequent use 


326 THERAPEUTICS AND MATERIA MEDICA 

leads to habit, which soon wrecks the entire physical, 
mental, and moral faculties. 

Opium contains seventeen alkaloids, of which morphin 
and codein are used most frequently. All forms of opium 
in time lead to habit. 

Morphin sulphate (morphince sulphas) is used exten¬ 
sively, administered by hypodermic, for the relief of pain, 
either alone or in combination with atropin. By com¬ 
bination of the two, the nausea, depression, constipation, 
and other bad after-effects of morphin are lessened or 
avoided. Atropin acts also as a cardiac and respiratory 
stimulant, and thus counteracts the depression produced 
by morphin in specially susceptible subjects. A moderate 
dose of morphin for an adult is from gr. £ to Atropin 
is combined in the proportion of gr. yis to to gr. I of 
morphin. 

Codein (< codeina ) is less powerful in its pain-relieving 
effects than fnorphin, less constipating, and less liable to 
create a habit. Dose, gr. ^ to j. 

Laudanum (tinctura opii) is given internally, either by 
mouth or rectum, and is used externally in lotions and 
liniments, chiefly for the relief of pain and for its astrin¬ 
gent effects. It contains about 44 grains of opium to the 
ounce; 60 minims yield, on the average, 120 drops. The 
dose is quoted at TRv to xxx. Regarding fatal doses, 
Potter states that in a child one day old 1 minim of 
laudanum caused death, and that a medicinal dose given 
to a nursing mother proved fatal to the infant. 

Heroin is another preparation of opium, used frequently 
in bronchitis and other respiratory affections. Adult dose, 
gr. tit to iV 

Paregoric (tinctura opii camphorata ) has about one- 
twentieth the strength of laudanum; 1 ounce contains 
nearly 2 grains of opium. It contains camphor and other 
ingredients. The dose for an adult is quoted at 3j to iv. 
The dose for infants needs to be carefully graded accord¬ 
ing to the age. For children under two years the dose 
ranges from Ttlj to xv. Many fatalities have attended 


NERVE SEDATIVES AND ANTIPYRETICS 327 

the promiscuous use of laudanum and paregoric. Chil¬ 
dren do not bear any of the opium preparations well. 

Signs of opium-poisoning are heavy sleep, from which 
the patient cannot be aroused, diminished respiration, 
contracted pupils, slow, full pulse. Atropin, caffein, and 
permanganate of potassium are antagonists to opium. 
Caffein is frequently given in the form of strong coffee. 
Permanganate of potassium is given dissolved in water, 
about gr. iij to v being an average dose. If the drug has 
been taken by mouth, the stomach should be promptly 
emptied by emetic. The bladder should be emptied, and 
the patient kept from relapsing into drowsiness and uncon¬ 
sciousness, if possible. A nurse would seldom if ever be 
justified in giving atropin without a physician's order. 
Strychnin and heat are used if needed, and artificial res¬ 
piration is often continued for hours. 

Salol, sodium salicylate, and salicylic acid are all 
produced from salicinum, a neutral principle obtained 
from species of willow and poplar trees. These drugs 
are used in acute rheumatism to reduce joint swellings, 
lower temperature, and relieve pain. All are diapho¬ 
retics. 

Salol is much used as an intestinal antiseptic. It is 
said to promote the healing of the ulcers in typhoid fever 
and to hinder reinfection. It causes profuse sweating, 
reduces temperature, relieves pain, and is occasionally 
followed by depression. It is considered non-poisonous. 
The dose ranges from gr. v to xx. 

Acetanilid ( azetanilidum ) or antifebrin relieves pain, 
produces sleep, and reduces temperature. It is a power¬ 
ful diaphoretic, a cerebral sedative, and depresses the 
heart. Many fatalities have attended its use. It is used 
in nearly all the patent headache powders. Dose for an 
adult, gr. ij to x. More than gr. xxx in twenty-four hours 
are rarely if ever given. Antikamnia is a proprietary 
remedy said to contain acetanilid and soda bicarbonate. 

Phenacetin ( phenacetinum ) resembles acetanilid in 
action, but reduces fever more gradually, and is less liable 


328 


THERAPEUTICS AND MATERIA MEDICA 


to cause collapse. It relieves pain and induces sleep. 
Dose, gr. ij to xx. , , . 

Guaiacol, a substance obtained from beechwood tar, 
is used chieflv to reduce temperature and as an expector¬ 
ant. Dose, lUv to xxx. Carbonate of guaiacol, gr. j to 
v. Guaiacol is sometimes given by simply applying it to 
the skin. It is used also as an intestinal antiseptic. 

Chloretone is obtained from chloroform. It produces 
sleep, is said to be non-poisonous, and without effect on 
the heart. Dose, gr. v to xx. 

Anesthetics are drugs which produce a condition of 
insensibility. They may be classified as local and general, 
the former acting only on the part to which the\ are ap¬ 
plied, the latter affecting the whole system. They are 
given to relieve the pain of surgical work; to lessen the 
suffering of childbirth; to overcome convulsions or general 
spasms from any cause; to produce muscular relaxation 
in fractures and dislocations, and to aid in certain exam¬ 
inations of the body. 

Ether, chloroform, and nitrous oxid are the agents 
chiefly used for general anesthesia. 

Chloroform (< chlorojormum ) is preferred in brain and eye 
work, and when lung or kidney disease is present. 

Ether is not so powerful as chloroform, slower in produc¬ 
ing effects, but safer. Ether is a cardiac stimulant, but 
is contra-indicated in diseases of the respiratory organs. 

Ether is inflammable, while chloroform is not. 

Nitrous oxid (laughing gas) is frequently used as a pre¬ 
liminary to other general anesthetics, or to regain motion 
in ankvlosed joints. 

Cocam hydrochlorate (cocainee hydrochloridum) is the 
most widely used of all local anesthetics. It may be 
dropped from a medicine-dropper, used in the form of a 
spray, applied on cotton, or given hypodermically. 
Cocain solutions rapidly deteriorate in quality, and should 
be made as needed, the tablet being dissolved in a satu¬ 
rated solution of boracic acid. 

Sulphuric ether and ethyl chlorid are used as a spray. 


ANTISEPTICS AND DISINFECTANTS 


329 


Where no other local anesthetics are to be had, a mixture 
of ice and common salt, applied in a gauze bag for a suffi¬ 
cient length of time, will freeze the part, and an incision 
can be made without great pain. 


CHAPTER XXXVI 

ANTISEPTICS AND DISINFECTANTS 

Antiseptics are substances which prevent decomposi¬ 
tion and decay. They retard the growth of bacteria, but 
do not destroy them. 

Germicides and disinfectants are substances which 
destroy germs. 

Sterilization. —“An object is said to be sterilized when 
all the forms of life contained within it or on its surface 
are destroyed. All processes which sterilize are necessarily 
also disinfectants, but all disinfecting processes by no 
means cause sterilization. This distinction between dis¬ 
infection and sterilization arises principally from the fact 
that some of the microorganisms have spores which cor¬ 
respond to the seeds of plants, in being very much more 
resistant to all the influences which destroy the parent 
cells ” (Rosenau). 

Ice is an antiseptic in its action, as no germ can multiply 
without a certain degree of warmth. 

Salt and sugar are both antiseptic in their action on 
meat or vegetable matter. They preserve from decom¬ 
position, but do not destroy infectious germs. Normal 
salt solution is one of the much-used antiseptic solutions. 
It is used for irrigation of wounds, for douches of various 
kinds, and as a stimulant in case of collapse, hemorrhage, 
septicemia, and coma. In its composition it closely re¬ 
sembles blood-serum. It is made by dissolving 1 dram 
of common salt (sodium chlorid) in 1 pint of water. 



330 THERAPEUTICS AND MATERIA MEDICA 

Boracic or boric acid (<acidum boricum) is produced 
from borax by combining with sulphuric acid. It is much 
used in surgical work for its antiseptic and unirritating 
qualities. A solution of 1 : 133 checks the growth of 
bacteria. It is generally used as a saturated solution. 
Boric lint or gauze is made by soaking the gauze in a boil¬ 
ing saturated solution and drying. It is said to contain 
nearly one-half its weight of the acid. 

Borax (sodmm borate) is much used externally as a 
lotion. It is antiseptic and disinfectant, having the power 
to destroy many forms of bacteria. 

Peroxid of hydrogen (hydrogenii dioxidum) or oxy¬ 
genated water is classed as a non-toxic antiseptic. When 
applied to suppurating wounds it produces a foam—the 
result of its chemical action on pus. It is said that 1 part 
added to 1000 of water containing infectious germs is 
sufficient to destroy the organisms in twenty-four hours. 
It is much used as a gargle or spray to the throat and 
nasal passages. 

Carbolic acid ( phenol) has extensive and varied use 
as a disinfectant. It cannot be depended on to kill spores, 
and should not be used as a disinfectant in case of tetanus, 
malignant edema, or other diseases due to spore-bearing 
bacteria. Rosenau, quoting Behring, states that the germs 
of cholera, typhoid fever, diphtheria, and erysipelas are 
killed in one minute by a solution of 1£ per cent, of carbolic 
acid. It is generally used in a solution of from 3 to 5 per 
cent, for disinfectant purposes, and clothing or material 
requiring deep penetration should be left in the solution 
one hour. It is considered a more reliable disinfectant 
for soiled clothing, urine, and excreta than bichlorid of 
mercury, as it does not coagulate albuminous matter. It 
is not destructive to metals, fabrics, or colors, nor to wood. 
It should be dissolved in hot water and well shaken. Ex¬ 
tensive burns have been caused by neglect to have the 
acid thoroughly dissolved. It is a corrosive poison which 
is readily absorbed and rapidly diffused through the sys¬ 
tem. Severe constitutional results have been produced 


ANTISEPTICS AND DISINFECTANTS 


331 


by one vaginal douche of a moderately strong solution. 
A peculiar smoky or olive green color to the urine is one 
of the first signs of carbolic acid poisoning. This has 
occurred sometimes by absorption from dressings. It is 
one of the most rapidly acting poisons known. Alcohol 
neutralizes its effects. Cider vinegar is also an antidote. 

Creolin contains carbolic acid and other ingredients 
held in solution by soap. It is said to be equal to carbolic 
acid in disinfectant properties, but its field of usefulness 
is more limited, owing to the dark stains it produces. 

Lysol forms a soapy, frothy liquid when added to water. 
It is more powerful as a germicide than carbolic acid, and 
has an irritant and caustic action on the skin and mucous 
membrane. One authority who recommended its use in 
obstetric and gynecologic work states that a solution of 
1: 200 destroys streptococci in fifteen minutes. It is used 
considerably as a disinfectant for the skin and in vaginal 
douches, but is rarely used for a disinfectant for utensils, 
owing to its cost. It is rarely used on the skin in a solu¬ 
tion stronger than 2 per cent, and a solution of J of 1 per 
cent, has caused severe irritation on a sensitive skin. 

Bichlorid of mercury is one of the most valuable and 
powerful disinfectants. It kills both germs and their 
spores. It corrodes metal and coagulates albuminous 
matter, making penetration impossible. It should, there¬ 
fore, not be used for the disinfection of sputum, feces, 
urine, or clothing soiled with these substances. It should 
not be used for disinfecting water-closets or plumbing, as 
in time it renders lead pipes brittle and worthless. It is 
more powerful as a germicide if used hot. On the flesh 
it acts as a corrosive poison, and has produced painful 
burns when applied to the vaginal mucous membrane in 
a too strong solution. 

Rosenau 1 gives the following facts regarding its potency: 
“A solution of 1: 1000 is ample for the destruction of all 
the non-spore-bearing bacteria at the ordinary tempera¬ 
tures, provided the exposure is continued not less than 
1 Disinfection and Disinfectants. 


332 THERAPEUTICS AND MATERIA MEDICA 

one-half hour. Many bacterial cells are killed at once 
when brought in direct contact with a solution of this 
strength, and the great majority are destroyed in fifteen 
minutes; but the extra time, as given, allows for pene¬ 
tration, which is usually required in actual practice. Solu¬ 
tions of bichlorid of mercury of the strength of 1: 800 and 
1: 500 are very strong germicides and will kill non-spore- 
bearing infections in a short time. For spores a solution 
of 1: 500 is necessary and an exposure of one hour. Arti¬ 
cles may be disinfected by immersing them in a solution of 
1: 2000, provided that the exposure is not less than two 
hours. A strength of 1 : 15,000 is sufficient to prevent 
putrefaction and fermentation.” 

Formalin consists of a 40 per cent, solution of formalde- 
hyd dissolved in water. A 4 per cent, solution of formalin 
is about equivalent to a solution of bichlorid of mercury 
of 1 :1000, and superior in germicidal properties to carbolic 
acid in a 5 per cent, solution. It is not much used as a 
disinfectant for the sick room except as a gas, but large 
quantities of roots, bulbs, fruit, and similar articles are 
disinfected by it in quarantine stations. It is used in 
agriculture to destroy parasitic growths on vegetables and 
fruit. It is believed to be non-poisonous and is sometimes 
added to milk and other liquid foods as a preservative. 
It is said that a very small amount, 1 : 25,000 or less, is 
sufficient to arrest the development of bacteria in these 
substances. 

Formaldehyd gas is the substance usually depended 
on for disinfection of rooms. No gaseous disinfectant can 
be depended on to disinfect beneath the surface, and it is 
considered best to obtain a large volume of gas in a short 
time. For this reason, lamps and many slow-acting gener¬ 
ators are considered an unreliable method of using it. It 
has no injurious effect upon fabrics or colors. It should 
never be used in a room in which the temperature is below 
50° F. A higher degree of heat aids the disinfecting power 
of the gas. A certain amount of moisture in the air is also 
needed for efficient disinfection, and a bucket of boiling 


ANTISEPTICS AND DISINFECTANTS 


333 


water should be set in the room previous to liberating the 
gas. It has the power of killing spores, but as these are 
often incorporated in albuminous matter or dust, long ex¬ 
posure is necessary, and it does not penetrate below the 
surface of mattresses, quilts, or any article. It is not an 
insecticide and has practically no effect on bed-bugs, 
roaches, and such vermin. 

Liquid ammonia sprinkled about the room is said to be 
useful in neutralizing the fumes after disinfection is com¬ 
pleted. 

The germicidal properties of formaldehyd gas are in¬ 
creased by combining it with permanganate of potassium. 
One pint of formaldehyd for each 1000 cubic feet of air 
space is considered sufficient. To this is added 3J ounces 
of permanganate of potassium. The potassium crystals 
are put into a tin vessel or pail, which is set inside a wooden 
or pulp bucket, and the formaldehyd poured over them, 
after the room has been properly sealed. This method 
is considered by many authorities more reliable than the 
sheet method, in which the formaldehyd is sprayed on a 
sheet which is hung over a line. When combined with 
the potassium permanganate it has proved more uniformly 
effective, and less likely to be hindered in action by change 
of temperature or the degree of moisture. A sixteen- 
hour exposure is considered sufficient. It is stated that 
much of the formaldehyd sold in the United States cannot 
be relied on, and that to be effective it must be of not less 
than 38 per cent, in strength. 

Tablets or powders containing the required amount of 
permanganate of potassium to combine with formaldehyd 
for disinfection are obtainable in modern drug stores. 

Sulphur gas is comparatively seldom used, but is an 
efficient surface disinfectant. It does not kill spores. It 
also requires moisture. It injures metal and cotton and 
linen fabrics. Authorities on disinfection state that 5 
pounds burned in 1000 cubic feet of space will kill non¬ 
spore-bearing germs after sixteen hours’ exposure. It has 
the advantage of cheapness and can usually be readily 
obtained. In arranging it, it is considered best to place 


334 THERAPEUTICS AND MATERIA MEDICA 

it in several vessels rather than all in one, especially if a 
large room is to be disinfected. The gas is generated by 
saturating the sulphur with alcohol and igniting. Care 
should be used to avoid fires. 

Milk of lime is one of the least expensive of all disin¬ 
fectants. It can be used to disinfect excreta in the sick 
room or in sinks, drains or stagnant pools, or to white¬ 
wash exposed surfaces. Lime which has been exposed to 
the air soon becomes inert. Solutions should be freshly 
made at least every two days. 

The hydrate of lime is made by adding 1 pint of water 
to 2 pounds of lime. The milk of lime contains 1 part of 
hydrate of lime to 8 parts of water. Air-slaked lime is 
worthless, but the dry hydrate may be preserved for some 
time in an air-tight container. The milk of lime should 
be added in quantity equal to the amount of excreta to be 
disinfected and thoroughly mixed. Two hours’ exposure 
is necessary. 

Pure dry quicklime may be freely mingled with the 
mass and will disinfect in less time. 

Chlorid of lime is said to be one of the strongest dis¬ 
infectants known, and is useful in the disinfection of ex¬ 
creta, sinks, water-closets, and drains. It is usually made 
in a 4 per cent, solution, which requires approximately 6 
ounces of lime to the gallon. It should never be used to 
disinfect clothing of any kind, as it ruins the fabric. 

Oxalic acid and permanganate of potassium have a 
somewhat limited field of application, being used princi¬ 
pally as disinfectants of the skin and mucous membrane. 

Oxalic acid is a corrosive poison, one of the most rapidly 
acting of all poisons, causing death in a few minutes when 
taken internally in poisonous doses. 

Permanganate of potassium is frequently employed 
for irrigation when fetid discharges are present, and is 
also used for internal medication. When used in solution 
as a disinfectant, a strength frequently employed is 1 dram 
of the crystals to 1 pint of water. 

Oxalic acid injures the metal coating of sinks and basins 
and will destroy linen, cotton, or similar material if ex- 


MISCELLANEOUS REMEDIES 


335 


posed to it for any length of time. Weak solutions of 
chlorid of lime and oxalic acid are sometimes used for 
bleaching, but the process requires much care or the article 
will be damaged. Oxalic acid in solution effectively 
removes the stains made by permanganate of potassium. 

Alcohol is used as a disinfectant, particularly for fine- 
edged cutting instruments, sutures, and for the skin; it 
is also used to neutralize carbolic acid which has. been 
used pure for disinfection. Commercial alcohol contains 
91 per cent, absolute alcohol with 9 per cent, of water. 
Alcohol in the strength of 70 per cent, is sufficient for 
disinfection of these materials. 

Percentage Solutions.—One fluidounce of water (480 
minims) weighs 456.4 grains. One pint of water (7680 
minims) weighs 7302 grains or, practically, 7300 grains. 
A 10 per cent, solution or 1 :10, it will thus be readily seem 
is one which'contains 730 grains of some substance in 1 pint- 

To prepare 1 fluidounce of a solution the following table 
may be convenient: 


Required to contain of a 
substance. 

Take of the substance 
(approximately). 


0.1 per cent. 
0.5 

1 “ 

2 “ 

3 “ 

4 “ 

5 “ 

6 “ 

7 “ 

8 “ 

9 “ 

10 “ 


0.46 grain ( y, gr. 

2.28 “ ( 2 Q “ 

4.56 “ 4j| “ 

9.13 “ ( 9 “ 

13.69 “ (13V< “ s 

18.26 “ (18(1 “ 1 

22.82 “ (23 “ < 

27.38 “ (27K *• 

31.95 “ (32 ~ “ 1 

36.51 “ (36U « ) 

41.08 “ (41 “ 

45.64 “ (45^ “ 

| 

) 

) 

) 

> 

1 



And enough water to 
make 1 fluidounce. 


CHAPTER XXXVII 

MISCELLANEOUS REMEDIES 

The term “specific,” as applied to remedies, is used in 
speaking of any medicine which exerts a peculiar influence 
over any part of the body; or one which prevents or cures 































336 THERAPEUTICS AND MATERIA MEDICA 

disease by a peculiar adaptation, to that disease and not 
on general principles. 

Specifics.—There are but very few drugs which exert 
this specific action on disease. The chief ones are mercury 
and iodid of potassium, which exercise a special curative 
action in syphilis; quinin, in malaria; and antitoxin, in 
diphtheria. 

Mercury ( hydrargyrum ) or quicksilver is a shining, 
silver-white, fluid metal. In the system its different prepa¬ 
rations exert various actions. Some of its salts are cor¬ 
rosive poisons; others act as local caustics; others as tonics, 
purgatives, alteratives; while others check inflammation 
and promote absorption. It stimulates most of the glands 
of the body, has a tendency to accumulate in the liver, is 
quickly absorbed by the blood, and remains in the tissues 
for an indefinite time, producing a gradual change. In 
small doses mercury for a time may act as a blood tonic 
and improve the general condition, but if long continued, 
waste is promoted by overstimulation of the lymphatic 
system and salivation. It is said that salivation is most 
likely to follow blue mass pills (of which mercury is an 
ingredient). Salivation occurs less frequently as an effect 
of calomel and gray powder. Individual susceptibility 
plays a prominent part in salivation. It occasionally 
occurs after one moderate dose. It is most likely to occur 
after mercury has been administered internally and by 
inunction. It is said that an acute coryza not infrequently 
follows a large dose of blue mass pills which has not been 
followed by a saline cathartic, the individual exhibiting 
all the signs of an acute severe influenza. Mercury is used 
in solution, ointment, powder, pill, tablet, and plasters. 

Among the preparations of mercury are: 

Calomel (hydrargyri chloridum mite). 

Gray powder (hydrargyrum cum creta) or mercury with 
chalk. 

Blue mass (massa hydrargyri), mass of mercury, other¬ 
wise known as blue pill, contains mercury, licorice, gly¬ 
cerin, and other ingredients. 


MISCELLANEOUS REMEDIES 


837 


Protoiodid of mercury (hydrargyri iodidum flavum) or 
yellow mercurous iodid. 

Biniodid of mercury {hydrargyri iodidum rubrum ) or red 
iodid of mercury. 

Bichlorid of mercury {hydrargyri chloridum corrosivum ), 
corrosive sublimate. 

Black wash (lotio hydrargyri nigri), made by applying 
calomel gr. xviij to lime-water 3x. 

Yellow wash {lotio hydrargyri flava), made by adding 
corrosive sublimate gr. xviij to lime-water 3x. 

Symptoms of overdosing with mercury are fetid breath, 
swollen and spongy gums, with a bluish line along the 
margin, loosening and soreness of the teeth, an excessive 
flow of saliva and a metallic taste, ulceration of the lips 
and tongue. 

Albumen in some form, usually the white of egg, is used 
as an antidote in case of accidental overdosing. It should 
be promptly followed by an emetic. 

In giving mercurial ointment by inunction it is a safe 
precaution to cover the hand with a rubber glove to pre¬ 
vent absorption of the drug by the hand, as well as pos¬ 
sible infection by specific poison. 

Bichlorid of mercury is the most actively poisonous of 
all the mercurial preparations. In poisonous doses inter¬ 
nally it acts as a powerful gastro-intestinal irritant, pro¬ 
ducing a burning pain, suppression of urine, bloody stools, 
collapse, and death. The application of a too strong solu¬ 
tion to the mucous membrane produces a burning sensa¬ 
tion; the tissues are corroded and ulcerated. 

Iodin {iodum) acts as an irritant to the skin and mucous 
membrane, and in large quantity may produce blistering. 
Among its preparations are: 

Tincture of iodin {tinctura iodinii ). 

Iodoform {iodoformum). 

Iodid of potassium {potassii iodidum), 

Iodid of ammonia {ammonii iodidum). 

Iodid of sodium {sodii iodidum). 

Aristol , iodol, antiseptol, and various other similar prep- 
22 


338 THERAPEUTICS AND MATERIA MEDICA 

arations are chemical productions of iodin combined with 

other substances. ... 

Iodid of'potassium is the form in which iodin is most fre¬ 
quently used internally. It is used to counteract various 
pathologic conditions, to promote absorption of morbid 
products, and to aid in the elimination of certain poisons. 
It is occasionally used as an expectorant and in weak so¬ 
lutions as a gargle. It is given dissolved in water. A 
solution of iodid of potassium is frequently made in the 
strength of 1 dram of the powder to an equal amount of 
water, of which 1 minim is equivalent to 1 grain of the 
powder. This may be given in milk or pepper mint-water 
to cover the disagreeable taste. 

lodism is a term applied to the general condition pro¬ 
duced by the use of iodin in too large a quantity. Among 
the signs are catarrhal inflammation of the air-passages, 
sore throat, hoarseness, headache, salivation, and fever. 

Antitoxin is a curative serum, consisting of the blood- 
serum of animals which have been rendered immune from 
infectious diseases by injection of the specific toxin of those 
diseases. Of these the most valuable are the diphtheria 
and tetanus antitoxins. 

Lanolin is an emollient preparation made from fats 
obtained from sheep’s wool and used as a base for various 
external applications. 

Glycerin (glycerinum) is a clear, syrupy liquid obtained 
by the decomposition of animal or vegetable oils. It is 
antiseptic and emollient in action, abstracts fluid from 
the tissues, and is freely absorbed by the skin and mucous 
membrane. Internally in large quantities it acts as a 
laxative. It is used as a vehicle for many other drugs. 

Vaselin ( petrolatum ) is the commercial name for a 
preparation obtained from petroleum by distillation. It is 
used as an emollient and protective dressing in skin irrita¬ 
tion and as a base for ointments. 

Albolene is a refined product of petroleum. It is used 
as a basis for ointments or in liquid form to dissolve various 
drugs used for sprays. 


MISCELLANEOUS REMEDIES 


339 


Witch hazel ( hamamelis ) is made from the leaves of 
the shrub hamamelis virginiana. It is said to be astriri- 
gent, styptic, and sedative. It is used internally and ex¬ 
ternally and is valuable in venous congestion and local 
inflammation. It is said to have special value as an appli¬ 
cation in hemorrhoids, varicose veins, and ulcers. Pond’s 
Extract is a proprietary remedy, said to contain the active 
principles of the plant. 

Arnica, in its various preparations and doses, acts as an 
irritant, stimulant, depressant, antipyretic, and diuretic. 
The tincture of arnica in water is much used as a local appli¬ 
cation in case of sprains or bruises. It prevents the swell¬ 
ing and discoloration caused by bruises, but may cause 
great irritation of the skin and eczema. It should not be 
used if the skin is broken. 

Ergot ( ergota ) is obtained from a fungus growth on rye, 
wheat, and other grains. It has a wide field of applica¬ 
tion, but is chiefly used to promote uterine contractions 
after childbirth and to check hemorrhage. 

Linseed ( linum ) or flaxseed is used internally to pro¬ 
mote expectoration and diuresis, and as a demulcent in 
coughs or sore throat. 

Linseed tea is made by pouring 1 pint of boiling water 
over 3 tablespoonfuls of flaxseed. Licorice root, in the 
proportion of 1 ounce to this quantity, or sliced lemons 
and sugar are sometimes added. The preparation is kept 
hot, but not allowed to boil, for one hour and then strained. 
The patient is allowed to sip freely to relieve cough. It 
is also used in cases of bladder irritability. 

Linseed oil is used occasionally as a remedy for hemor¬ 
rhoids, as a dressing for old varicose ulcers, by enema as 
a laxative, and, less frequently, by the mouth. Ground 
linseed meal is considered the best substance for poultices. 

Lime liniment ( carron oil) consists of equal parts of 
linseed oil and lime-water, well shaken. It is a favorite 
remedy for burns. 

Lime (« calcium oxid) is an important constituent of the 
body. It gives firmness to the bones and is also found in 


340 THERAPEUTICS AND MATERIA MEDICA 

solution in the tissues. Internally it acts as slightly seda¬ 
tive to the mucous membrane, and as an antacid and 
astringent. Calcium chlorid is used to promote coagula¬ 
tion of the blood. 

Lime-water (liquor calcis) is a solution of lime in water. 
This rapidly decomposes by exposure to air. It is used 
as a saturated solution and is quickly made by pouring 
about 2 quarts of water over a piece of fresh unslaked lime 
the size of an egg. It should be stirred till slaked and 
let stand till it is clear. The water is then poured off. 
The milky sediment will settle to the bottom, but this 
sediment should never be given. It is used as a gastric 
sedative, and is added to milk to prevent the formation 
of dense indigestible curds in the stomach. The dose is 
usually about 2 tablespoonfuls to 1 glass of milk. 

Camphor is obtained from trees growing in China, 
Japan, and other eastern countries. It is used internally 
as a sedative in hiccough, hysteria, and other nervous 
affections. Inhaled, it acts as a stimulant to the heart 
and respiration. It is also used as a remedy for influenza, 
either inhaled or taken by mouth. Externally it acts as 
a sedative. It is contained in many liniments, and is 
frequently applied in case of sprains, lumbago, neuralgia, 
and other local affections. 

Hops ( humulus ) act as a bitter tonic and promote 
sleep, and have a diaphoretic and astringent action. Ex¬ 
ternally, hops are used as a poultice for the relief of pain 
by pouring hot water over the leaves. Made into pillows, 
fresh hops are occasionally used for their sedative effect 
by nervous invalids. 

Capsicum {Cayenne pepper) is used in flatulent colic to 
relieve pain; in alcoholic and opium cases as a substitute 
for those drugs. It increases saliva, promotes digestion, 
acts as a stimulant to the heart, also as a diaphoretic and 
diuretic. Externally it acts as a rubefacient and vesicant. 
It is irritant to the mucous membrane and in too large 
doses may excite gastritis. 

Ginger {zingiber) acts as a stimulant, assists in the ex- 


MISCELLANEOUS REMEDIES 


341 


pulsion of gas from the stomach and bowels, produces a 
sense of warmth in the stomach and abdomen, and relieves 
pain in those regions. 

Mustard ( sinapis ) is used internally chiefly as a con¬ 
diment, an emetic, and occasionally to expel gas from the 
intestines. Externally it is used as a rubefacient, counter- 
irritant, and nervous stimulant. It causes heat, redness, 
severe pain, and, if the application is prolonged, vesication. 

Turpentine (terebinthina) is used externally, chiefly as 
a rubefacient and antiseptic. Internally it has a varied 
action. It is given in cases of ulceration and hemorrhage 
of the intestines, to relieve flatulent colic, and in cases of 
bronchitis. 

Oil of turpentine (oleum terebinthince) , commonly called 
spirits of turpentine, is the preparation most frequently 
used. 

Sanitas is a watery solution of turpentine which con¬ 
tains camphor and other ingredients. It is used as an 
external disinfectant. 

COMMON POISONS AND THEIR ANTIDOTES 

Poisons may be divided into two classes—irritants and 
narcotics. 

Irritants act quickly as soon as they enter the alimentary 
tract, causing burning and destruction of tissue and severe 
pain. 

Narcotics act more slowly, as they must be absorbed 
and enter the circulatory system before producing their 
effect. They produce drowsiness, passing gradually into 
unconsciousness, and ending in death. 

General Treatment of Poisoning. 1 —“After determining 
the nature of the poison, the first indication is to administer 
a chemical antidote so as to prevent any further action of 
the noxious agent on the organism. Unless there has al¬ 
ready been free vomiting or there is evidence of severe 
corrosion, the stomach should be evacuated without delay 

1 From “Pocket Therapeutics and Dose-Book,” Morse Stewart, Jr., 
M. D. 


342 


THERAPEUTICS AND MATERIA MEDICA 


either by means of the stomach-pump or the administration 
of an emetic. In the majority of cases the pump should be 
given the preference, as it causes less exhaustion and is 
more prompt and reliable in its action. The best emetics 
are copper sulphate, 5 gr.; zinc sulphate, 10 gr.; powdered 
ipecac, 20 gr.) common salt, 2 drams to a pint of water, 
mustard flour, 2 drams in a cup of warm water; and apo- 
morphin hydrochlorid, X V to | gr., hypodermically. The 
last is especially valuable in narcotic poisoning, when 
stupor renders the administration of drugs by the mouth 
difficult or impossible. In poisoning by all irritant sub¬ 
stances demulcents are also indicated. They soothe and 
protect the injured mucous membrane. The best repre¬ 
sentatives of this class are white of egg, starch-water, 
flaxseed-tea, gelatin, milk, and oil. Oily demulcents 
should be avoided, however, when the poison is phos¬ 
phorus or cantharides, since absorption of these agents 
is facilitated by fatty matter. Cathartics should be em¬ 
ployed whenever there is reason to believe that any of 
the poison has entered the intestinal canal. As a rule, the 
best are magnesium sulphate and castor oil. 

“If the poison has been absorbed, remedies are given and 
measures are employed to counteract its effect on vital 
processes (physiologic antidotes). Thus, in failure of the 
respiration it may be necessary to give atropin, ammonia, 
strychnin, or caffein hypodermically, to employ artificial 
respiration, and to administer oxygen; in case of syncope 
or collapse, to apply external heat, to administer diffusible 
cardiac stimulants, and to inject normal salt solution under 
the skin or into a vein; or if there be violent convulsions, 
as in strychnin-poisoning, to give sedatives, like chloral, 
bromids, amyl nitrite, and chloroform.” 


POISONS—SYMPTOMS, ANTIDOTES, TREATMENT 


MISCELLANEOUS REMEDIES 


343 


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POISONS—SYMPTOMS, ANTIDOTES, TREATMENT ( Continued ) 


346 


THERAPEUTICS AND MATERIA MEDICA 


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burning sense in throat and stomach; antidote; hydrated magnesia, potassium 

nausea; vomiting; pulse small and fre- permanganate, lime-water also recom- 











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■h h P 


^ Jh CO 


73 

q 

cd 


q 

OJ 

'o 
.5 g “ 

cJ.2 T3 


O 

CJ 


+3 

q 

<d 

g,-- 

cr 

2 q 

^ 12 


CD ^ 

p > £ 

d o D 

m 


icc 

c3 


c3 
CJ 

q ^ 

® 



351 


Poisonous mushrooms. Nausea; heat and pain in stomach and Brisk emetic, then Epsom salts; atropin 

bowels; vomiting and purging; thirst; in full doses hypodermically; alcoholic 

convulsions and faintings; pulse small stimulants; external heat. 

and frequent; stupor; dilated pupils; 
cold sweats. 


























































. 








NOTES 
























* 
















































































‘ 






































































































































































































































































' 





























NOTES 





' 

. 

. 






SECTION VI 

dietetics 


CHAPTER XXXVIII 
THE PRINCIPLES OF NUTRITION 

“The nutrition of the body involves four distinct proc¬ 
esses : 

“ 1. The secretion of digestive fluids and their action 
upon food in the alimentary canal. 

“ 2. The absorption of the ingredients of the food when 
digested into the blood-vessels and lymphatic vessels. 

“ 3. The assimilation of the absorbed nutritious products 
by the tissues. 

“4. The elimination of waste material ” (Thompson). 

Foods are substances which supply the living organ¬ 
ism with the elements necessary for growth and repair, 
and with the energy needed for the exercise of its func¬ 
tions. 

A food, to be complete or perfect, must of necessity con¬ 
tain all the elements of which the tissues, fluids, and solids, 
of the body are composed. 

In the lessons on anatomy and physiology it was found 
that from fifteen to twenty chemical elements are found 
in the body, of which the most important are oxygen, 
hydrogen, carbon, nitrogen, calcium, phosphorus, and 
sulphur. 

Water constitutes about 60 per cent, of the body weight 
and is an important element of food, though it cannot be 
burned in the body and does not yield energy. 

23 


353 



354 


dietetics 


The uses of water in the body are: 

1. It renders the tissues soft, elastic, and flexible. 

2. It dissolves nutritive material and conveys it in fluid 
form to the various parts of the system. 

3. It assists in the distribution and regulation of the 

heat generated in the body. 

4. It assists in dissolving and carrying off waste 

material. 

5. It moistens the skin and surfaces and acts as a lubri¬ 


cant, preventing friction. 

Food Compounds.— The various elements of the body 
are combined so as to form a variety of compounds, which 
exist also in foods, and serve in building and repairing the 
tissues, supplying heat and muscular force or energy, 
or the power to work. The most important food com¬ 


pounds are: 

1. Proteins. 

2. Carbohydrates. 

3. Fats. 

4. Mineral matter. 

5. Water. 

Nitrogen.—Of all food elements, nitrogen stands first 
in importance. It is an essential constituent of all living 
things. Activity and change which distinguish living 
from inanimate things are only found where nitrogen is 
present. Hence, foods are frequently classified as nitrog¬ 
enous and non-nitrogenous. 

Nitrogenous foods furnish the greater part of the material 
needed for tissue building. 

Non-nitrogenous foods contribute to the production of 


heat and force. 

Foods are also classified as organic and inorganic, the 
organic including foods derived from the vegetable or 
animal world; the inorganic including mineral foods, such 
as water, salt, phosphorus, etc. It should be remembered 
that foods are often classified according to their most 
important ingredients, while they contain many other 
elements. Also that nitrogenous foods do contribute to 


THE PRINCIPLES OF NUTRITION 355 

a certain extent in producing heat and force, but tissue 
building and repair are their chief functions. 

Alimentary Principles. —It has been stated that foods 
are often classified according to their chemical ingredients 
or compounds (which are often spoken of as alimentary 
or food principles) into proteins, carbohydrates, fats, min¬ 
erals, and water. 

1. Proteins is a term used to include the principal 
nitrogenous compounds, whether animal or vegetable. 

Animal Nitrogenous Substances. —The principal animal 
nitrogenous substances are: 

Albumen, found in the white of an egg. 

Casein, found in milk. 

Fibrin, found in the blood. 

Myosin, found in the muscle. 

Gelatin, found in the bone and ligaments. 

Vegetable Nitrogenous Substances. —The principal are: 

Gluten, found in all cereal grains (sometimes called 
vegetable fibrin). 

Legumin, found largely in peas and beans. 

2. Carbohydrates or non-nitrogenous foods include 
all starches and saccharine substances used as food. 

Starch is found in many vegetables. 

Sugar is found in plants as cane- or beet-sugar, also in 
animals as sugar of milk ( saccharum lactis), a crystallized 
sugar obtained by evaporation from whey. 

3. Fats or hydrocarbons are obtained from both the 
animal and vegetable kingdom. 

Fats occur chiefly in animal foods, of which cream, but¬ 
ter, meat, etc., are examples. They are also found in the 
vegetable world, of which olive oil and cotton-seed oil are 
examples. Fats also exist in the yolks of eggs, in some 
cereals, notably oatmeal, and in various nuts. 

4. Mineral substances include water and salts, are 
found in a great variety of foods, and form about 60 per 
cent, of the body weight. Phosphate of lime or calcium 
phosphate is an essential element of bone. Fresh lean 
meat and fish contain about 1 per cent, of mineral matter. 


356 


DIETETICS 


Milk yields a very small portion of mineral substance. 
Cereals and green vegetables and fruits range up to 2 per 
cent., while dried peas and beans contain from 3 to 4 per 
cent, of mineral matter. 


Tissue-building foods: 

Milk. Fish. Peas. 

Eggs. Cheese. Lentils. 

Meat. Beans. Peanuts. 

Heat- and force-producing foods: 

Cereals. Potatoes. Fats. 

Corn. Tapioca. Sugar. 

Rice. Sago. Honey. 


Vegetables containing little or no starch: 

Cabbage. Parsnips. Lettuce. 

Asparagus. Turnips. 

Spinach. Egg-plant. 

Celery. Artichokes. 

Green beans. Tomatoes. 

Squash. Cucumbers. 


Radishes. 

Onions. 

Rhubarb. 

Cauliflower. 

Fruits. 


Energy Requirements for 

Usual physical 
condition of 
the individual. 

At rest.. 

Light exercise. .. 

Moderate exercise. 

Heavy muscular work. 


Normal Adults 

Calories per 
kilogram 
per day. 

. 30-35 

. 35-40 

. 40-45 

. 45-60 


Energy Requirements for Normal Children 


Age. 


1-2 . 

2-5. 

6-9. 

10-13. 

Girls: 14-17 


Boys: 14-17 


(Von Noorden’s allowance.) 


Calories per day. 
. 900-1200 
. 1200-1500 
. 1400-2000 
. 1800-2200 
. 2200-2600 
. 2500-3000 


In many respects the human body resembles an engine 
and is often spoken of as the human machine. In common 
with other machines it must have material, first, to build 












THE PRINCIPLES OF NUTRITION 


357 


it; second, to repair its several parts as they are worn 
out; third, to serve as fuel. Every thought, feeling, and 
motion of the body contributes to the waste of tissue, 
md requires that some tissue-building substances be sup¬ 
plied. Besides this, there is a certain amount of waste 
of tissue and energy in keeping alive. Every heart-beat, 
every breath, the processes of digestion and excretion—all 
require new material to repair the loss produced in the 
exercise of these functions. 

The human body, unlike other machines, builds itself, 
repairs itself, and regulates its functions while in health. 
It can, when necessary, use its own material as fuel to pro¬ 
duce heat. Excess of food beyond what the body needs is 
converted into fat and stored in the system. 

When coal is supplied to the engine, the energy or power 
latent in the coal is changed into heat and power needed 
for work. When food is supplied to the human body the 
same change takes place. The food is burned in the body 
by its contact with oxygen in the tissue, and the process 
is termed oxidation. Just as different kinds of coal or 
wood produce different quantities of heat and power 
when burned in an engine, so different foods have different 
heat- and force-producing properties. In chemical labora¬ 
tories this power is measured by a special apparatus called 
the calorimeter. The unit of measure is a calorie. A 
calorie or heat unit is the amount of heat required to 
raise 1 pound of water 4° F. 

Refuse. —Almost all food substances contain a certain 
amount of refuse. Some of this refuse has little or no 
nutritive value. Some cannot or should not be eaten, as, 
for instance, the seeds and skins of vegetables and fruits. 
Vegetables contain little real nourishment in proportion 
to weight, and are not valuable for persons with weak 
digestive organs. They contribute to the salts, acids, 
and water needed in the body and afford a pleasing variety. 
Also the woody or tough fiber in many vegetables, while 
indigestible, performs a useful function in contributing 
to the bulk of food needed for normal peristalsis. 


358 


DIETETICS 


The Tests of a Perfect Food—“1. A perfect food 
must contain all the nutritive elements of the body: 
Proteins, carbohydrates, fats, minerals, and water. . 

“ 2 . It must contain these in their proper proportions. 

“ 3 . It must contain in a moderate compass the total 
amount required daily. 

“ 4 . The nutritive elements must be capable of easy ab¬ 
sorption, and yet leave a certain bulk of unabsorbed 
matter to act as intestinal balance. It must be obtain¬ 
able at a moderate cost” (Hutchison). 

No one food fulfils all these requirements, hence, the 
necessity of a mixed diet whereby one food may be used to 
supplement what is lacking in another. “The foods best 
for health are those best fitted to the needs of the individ¬ 
ual. The cheapest food is that which furnishes the largest 
amount of nutriment at the least cost. The best food is 
that which is both most healthful and cheapest.” 

The laws which govern nutrition are not yet fully under¬ 
stood, but “the general metabolism or food exchange and 
use in the animal organism is now sufficiently well 
understood to admit of many safe and important con¬ 
clusions. 

“It is necessary to measure both the income of the 
body, that is, the food plus water and oxygen, and also 
the outgo, that is, the excretions which are practically all 
included in what passes out through the lungs, the skin, 
the kidneys, and in the feces. 

“Recently it has become possible to measure the 
oxygen consumed in breathing. . . . For measuring 

the carbon dioxid and water excreted a special apparatus 
has been devised which measures the oxygen consumed 
and the heat given off. This apparatus is known as a 
respiration calorimeter. 

“The respiratory quotient is obtained by dividing the 
volume of carbon dioxid evolved by the volume of oxygen 
used . 1 

Food accessories or adjuncts comprise the condiments 
i W. H. Jordan, The Principles of Human Nutrition. 


THE PRINCIPLES OF NUTRITION 359 

which give flavor to food or stimulate the digestive secre¬ 
tions, and such beverages as tea, coffee, cocoa, etc. 

Proteins is a term used to include the principal nitrog 
enous foods. 

Albuminoids is a term used to include substances similar 
to the white of egg (albumen), the lean of meat (myosin), 
the curd of milk (casein), and the gluten of wheat, albu¬ 
men being taken as the typical member of the group. 

Gelatinoids is used to include the substances obtained 
from bone, tendons, gristle, etc. 

Proteids is a term which includes gelatinoids and albu¬ 
minoids. 

Extractives is a term used to denote the ingredients found 
in meat extracts, broths, etc. 

Dextrose , glucose, or grape-sugar is found in grapes, 
honey, and sweet fruits. 

Cellulose is the basis material of the more or less solid 
framework of plants. 

Dextrin is a substance formed as an intermediate prod¬ 
uct in the transformation of starch into sugar. 

Lactose is the form of sugar found in milk. 


360 


dietetics 


CHAPTER XXXIX 


THE PRINCIPLES OF NUTRITION ( Continued) 


The nutritive value of food depends not only on the 
proportion of nutrients contained in it, but on the amount 
which the body can appropriate. It is not the amount 
that is eaten, but the amount that is digested and assimi¬ 
lated that becomes nutriment for the body. Individuals 
differ greatly in the amount of nutriment they are able 
to appropriate. 

The exact nutritive or caloric value of any food is of 
very much less importance to a nurse than the general 
relative value of foods. For instance, if a nurse were in 
charge of a patient in a family who with difficulty secured 
the necessities of life, it would be exceedingly foolish for 
her to spend money for celery or lettuce out of season, 
which might please the palate, but which have almost no 
nutritive value, when the money was needed for foods 
which would properly nourish. It is important for her 
to know that though the patient may like tea and coffee, 
those substances do not take the place of milk as food. It 
is important also for her to understand that while grape- 
juice or beef-broth may both be refreshing and relished, 
the proportions of nutriment contained in either is very 
small, and in the latter, especially, is a very variable 

quantity. . 

The ideal diet has been defined as that combination 
of foods which, while imposing the least burden on the 
body, supplies it with exactly sufficient material to meet 


its wants. 

Mixed Diet—In the ordinary individual, who has had 
the general comforts of civilization, the appetite revolts 
against a monotonous or one-sided diet. Thus, it has 
become customary to supply the nutrients from a variety 
of articles at each meal. It will also be recognized that 


THE PRINCIPLES OF NUTRITION 


361 


either instinct or custom has suggested many suitable 
combinations of common foods. For instance, bread 
contains protein and carbohydrate substances, but no fats, 
hence, we instinctively combine it with butter, which 
supplies the needed fat. Potatoes contain much starch 
and little nitrogenous material, hence, they are frequently 
combined with meat, milk, and eggs. Rice, which is 
largely starch, is combined, in cooking, with milk, which 
supplies elements in which it is lacking. 

Amount of Foods Required. —There are many things 
which enter into the question as to the amount of food 
needed, and also the proportions in which we should use 
the proteins, the carbohydrates, and fats. 

Prominent among these are: 

1. Age. 

2 . Size. 

3. Body weight. 

4. Degree of activity or exercise taken. 

5. Sex. 

6 . Climate and season. 

7. Appetite and general condition. 

8 . Idiosyncrasies. 

Age is one of the greatest determining factors. There 
are generally recognized three great divisions in human 
life: 

The age of growth and development. 

The period of adult life. 

The period of advanced age. 

The age of growth and development begins at birth and 
continues for about eighteen years. This may be divided 
into three periods: The period of infancy, from birth to 
two years; the period of childhood, from two to ten years; 
and the period of adolescence. Up to the age of one year 
the infant’s diet should be practically restricted to milk. 
Occasionally, it may seem necessary to add other food 
substances but, on general principles, milk is recognized 
as a complete food for infants. In the second year, a few 


362 


DIETETICS 


other carefully selected articles of diet are added, usually 
some well-cooked starchy substance, bread, meat juice, 
and broths. By the end of the second year the digestive 
functions have increased in power, teeth for mastication 
have been developed, and all the digestive organs are 
becoming adapted for a mixed diet. During the period of 
rapid growth the child needs more tissue-building food 
than in advanced age. Mineral salts are needed in large 
proportions. Fruits supply these, and nearly all young 
children crave sugar, which should be provided in modera¬ 
tion. Thompson gives the following list of foods which 
should be forbidden all children under four years of age: 
Fried food of all kinds; game; salt food; pork; pickles; 
salads; condiments, except salt; stew; the dressing of fowl; 
sauces; visceral food, such as liver, kidney, etc., all raw 
vegetables; potatoes, except baked; tomatoes in any form, 
the coarser vegetables, such as beets, turnips, cabbage; 
fancy breads; cake and pastry; griddle-cakes; canned food 
of all kinds; fancy confectionery; sweets and preserves; 
cheese; rich soups; dried or unripe fruits; nuts; fruit with 
large seeds, such as grapes; the skin of all poultry, fruits, 
or vegetables; tea; coffee; and alcohol in every form. He 
also gives the following general rules for feeding young 
children: 

“1. Allow time for meals. 

“ 2. See that the food is thoroughly masticated. 

“ 3. Do not allow nibbling between meals. 

“4. Do not tempt the child with the sight of rich and 
indigestible food. 

“5. Do not force the child to eat against its will, but ex¬ 
amine the mouth, which may be sore from erupting teeth; 
and examine the food, which may not be properly cooked 
or flavored. 

“ 6. In acute illness, reduce and dilute the food at once. 

“ 7. In very hot weather give about one-fourth or one- 
third less food, and offer more water.” 

The quantity of food required increases rapidly from 


THE PRINCIPLES OF NUTRITION 


363 


birth up to four or five years. Between four and ten the 
increase is very gradual. 

From ten to eighteen years of age development of the 
body is very rapid, and exceptionally large amounts of 
food are needed during that period. The development 
and education of the mind goes on through life, and may 
wisely proceed very gradually, but the development of 
the body is limited to a certain period, after which it 
is irrevocably arrested, therefore much care should be 
given to proper feeding during the years of physical 
growth. 

Throughout active adult life the food, both in charac¬ 
ter and quantity, should be regulated, to a certain extent, 
by occupation, habits of life, climate and season, and in¬ 
dividual capacity and needs. Mast people eat more than 
the body can assimilate and more than is needed for the 
repair of waste and the supplying of force, hence, the 
tendency to excess of fat and diseases caused by imperfect 
elimination and digestion. 

Obesity .—The term “obesity” is used to designate the 
excessive accumulation of body fat. In the majority of 
cases the condition is within the control of the individual. 

The remedy for obesity in most cases is either less food 
or more exercise. There are cases of obesity, however, 
which cannot be explained in the ways mentioned, and in 
which the reduction of food and increased exercise seem 
to have little or no influence on body weight. 

Diet in Advanced Age .—With advancing age there is 
a lessening of activity of the organs of the body. As a 
rule, the ability for muscular exercise grows less. The 
digestive organs share in the general decline of physical 
vigor. There is less need for food on account of lessened 
exercise, and less ability to digest and assimilate food. 
Slow degenerative changes are taking place in the whole 
alimentary tract, in common with other organs. These 
changes make it necessary for changes in the quality and 
quantity of food used. The ability to eliminate food un- 


364 


DIETETICS 


necessarily consumed diminishes, and excess of foods is 
certain to result in disease. 

The following general rules may, therefore, wisely be 
observed in arranging a diet for this period of life: 

1. To decrease the amount of food consumed. 

2. To give small quantities of food at frequent intervals 
and thus avoid overtaxing the digestive system with a 

heavy meal. . .. 

3. To choose foods that are nourishing and easily di¬ 
gested, and that do not yield an excessively large amount 
of indigestible residue as waste matter. 

Occupation.— The degree of muscular exercise taken 
should determine to a certain degree the quality and 
quantity of food. Those who are engaged in sedentary 
occupations require less food than those whose daily work 
involves active exercise in the open air. 

Temperament and disposition influence food require¬ 
ments. Persons of a sanguine type, being more active, 
use more energy than the phlegmatic, and the food re¬ 
quirements of these two types differ to some extent. 

The work of the body includes both the maintenance of 
its functions and the performance of labor the one termed 
“physiologic labor’ 7 and the other “mechanical.” The 
relation of food to work is important to remember m 
studying nutrition. , 

Climate and Season— As a rule, in tropical climates and 
during the hot season less animal foods and more vege¬ 
tables and fruits should enter into the diet. 

Se X . —Women, as a rule, require slightly less food than 

^Personal idiosyncrasy should always be considered. 
Comparatively few individuals can eat all foods without 
injury. Peculiarities may be due to inherited tendencies, 
to the growth of habit, or to other reasons, but they 
should not be disregarded. 

General Rules. —In regulating the diet, two important 
rules should be observed: 


THE PRINCIPLES OF NUTRITION 


365 


1 . Choose foods which agree and avoid those which 
cannot be digested without discomfort. 

2 . Use foods in quality and quantity that will supply 
the nourishment the body needs, and avoid burdening it 
with excess or superfluous food material which has to be 
disposed of at the cost of health and strength. Appetite 
should be regulated by reason. “A meal may be perfectly 
well balanced and yet not be dietetically correct. In other 
words, the metal may be in the ore, but the physical ma¬ 
chine incapable of extracting it. 

“An out-of-door worker, with plenty of oxygen at hand 
and no hard brain labor, can digest more food and food 
difficult of digestion, because his blood is not called 
away from the digestive organs to the brain, than can 
the man tied to a desk in a heated office, in school, or 
shop.” 

The digestibility of food may mean several things. 
It may mean the proportion of a given food, or each of 
its elements, which can be digested by an ordinary indi¬ 
vidual. 

It may mean to another person the time required to 
digest or the ease with which it is digested. 

It may mean to a third person whether the food agrees 
or disagrees with the person using it, while to a fourth 
it may mean due consideration of all these questions. 

The actual digestibility of any food is exceedingly hard 
to determine. All foods contain a certain amount of 
material which cannot be digested or utilized, and which 
passes out of the body as waste matter. The ability to 
assimilate or appropriate food varies greatly. • One person 
will put on flesh, while another will grow thin on the same 
diet, and approximately the same amount. 

Conditions which influence digestibility and assimilation 
of food: 

1 . The food which is said to disagree may not have been 
properly cooked. 

2 . It may have been eaten with improper combinations. 


366 


DIETETICS 


3. The nervous system powerfully influences the digest¬ 
ive process. The food may be digestible or easy to digest, 
and yet not be well or comfortably digested because of a 
peculiar nervous or mental condition. 

4 . The circulation may be poor. Vigorous healthy 
circulation promotes food digestion. 

5 . The blood may be impoverished, and poor material 
is provided for the secretion of digestive fluids. 

6 . The consistency of the food eaten has much to do 
with ease of digestion. 

7 . The food may not have been well masticated. 
Brubaker gives the following table, showing the length 

of time needed for stomach digestion. 

Hours. Minutes. 

1 20 

Eggs, whipped. . 

Eggs, soft-boiled., on 

Eggs, hard-boiled.^ 55 

Oysters, raw.. 3 q 

Oysters, stewed.. o n 

Lamb, broiled. . 

Veal, broiled.. 15 

Pork, roasted. 2 

Beefsteak, broiled.” 05 

Turkey, roasted." 

Chicken, broiled. 45 

Chicken, fricassed.. . 

Duck, roasted. t on 

Soup, barley, boiled.* 

Soup, bean.. 

Soup, mutton. on 

Liver, beef, broiled. 20 

Sausage...o 45 

Green corn, boiled...* 30 

Beans, boiled.. on 

Potatoes, roasted.- on 

Potatoes, boiled.. on 

Cabbage, boiled. on 

Turnips, boiled.. ^ 

Beets, boiled... on 

Parsnips, boiled. 

The table and chart which follow have a certain scien¬ 
tific interest and value, but the best medical authorities 
have stated that in practical feeding these tests of food 
cannot be strictly applied either in health or disease. It 





























THE PRINCIPLES OF NUTRITION 


367 


is regarded as “wholly impracticable to prescribe an in¬ 
valid dietary on a basis of calories as representing energy 
or heat, or a matter of storage of body substances, as one 
should definitely prescribe a medicine.” 

Balanced feeding for farm animals has received very 
careful study by scientists, and most farmers realize the 
necessity of properly balanced rations. A large propor¬ 
tion of the American people, however, are accustomed to 
pay very little attention to food values in arranging their 
daily dietaries. Human foods are now largely made 
up of what may be called artificial products (that is, 
materials so modified by some manufacturing process) 
that they almost wholly lack nutrients of one or more 
classes. It is very easy to select a diet that is insufficient 
for proper body building and repair, while apparently the 
proper food elements are used. 

Artificial Food Products.— Examples of how the food 
value of a vegetable or animal product may be greatly 
altered in process of manufacture are easily found. 

Wheat flour is one of the staple foods in every family. 
In making it from the wheat grains the outer coat, or 
bran, is separated. This outer coat contains much mineral 
substance, particularly phosphorus, calcium, and mag¬ 
nesium. 

Starches and Gums .—In the making of cornstarch, sago, 
and tapioca certain valuable compounds found in the 
original plant are removed. 

Similar modifications result in the manufacture of sugar 
from the sugar beet and sugar cane. Butter substitutes 
are numerous. 

Cereal products may be so changed in making into ready- 
cooked foods that the proportion of nutrient material 
may be very small and the cost very high. 

SEVEN RULES FOR MEAL PLANNING 

1. Use a tempting morsel to stimulate gastric secre¬ 
tion. 


dietetics 


368 

2. Include fats, proteins, and carbohydrates in proper 
proportions. 

3. Add coarse material to aid digestion. 

4. Always include a raw food. 

5. Avoid repetition of flavor. 

6. Strive for variation in texture. 

7. Supply a high point of interest. (Atwater., 

Comparative Cost of. Digestible Nutrients and Energy in 
Different Food Materials at Average Prices. 

q t ab0Ut 


Kind of food material. 


Beef, sirloin 

a << 

(4 « 

Beef, round 

44 « 

44 <* ... 

Beef, shoulder ^ clod 

Beef, stewing meat 
Beef, dried, chipped 
Mutton chops, loin 
“ “ leg 

“ le F 

Roast pork, lorn . 
Pork, smoked ham 


rt 

S3 

o 

p. 


Ph 


Cts. 

25 

20 

15 

16 
14 
12 
12 

9 

5 

25 

16 

20 

16 

12 

22 

18 


oS 

1& 

O 


Dolls. 

1.60 

1.28 

.96 

.87 

.76 

.65 

.75 

.57 

.35 

.98 

1.22 

1.37 

1.10 

.92 

1.60 

1.30 


Amounts for 10 cents. 


Cost of 1000 calo: 
ies energy. 1 

Total weight of 
food material. 

Protein. 

C3 

pH 

Carbohydrates. 

Energy. 

Cts. 

Pds. 

Pd. 

Pd. 

Pds . 

Cals. 

25 

0.40 

0.06 

0.06 


410 

20 

.50 

.08 

.08 

• • 

515 

15 

.67 

.10 

.11 


685 

18 

.63 

.11 

.08 


560 

16 

.71 

.13 

.09 


630 

IS 

.83 

.15 

.10 


740 

17 

.83 

.13 

.08 


595 

13 

1.11 

.18 

.10 


795 

7 

2.00 

.29 

.23 


1530 

32 

.40 

.10 

.03 


315 

11 

.63 

.08 

.17 


890 

22 

.50 

.07 

.07 


445 

18 

.63 

.09 

.09 


560 

10 

.83 

.11 

.19 


1035 

13 

.45 

.06 

.14 


735 

11 

.56 

.08 

| .18 


915 


~ . The cost of 1 pound of protein “XufreSard'“totCImSunte ffYhe othlr 
rial to furnish 1 P ou "f k ^fse the costSf ener^r means the cost of enough mate- 
nutrients present. Likewise, tne cost ui eiicifey kinds and proportions of 

rial to furnish 10M glories, wiUiout reference to^th^kinas^ ^ 

SnandSrorrect.ffi that neither gives credit for the value of 
th Fr°om e Bulletin No. 142, United States Department of Agriculture. 




















































THE PRINCIPLES OF NUTRITION 


369 


Comparative Cost of Digestible Nutrients and Energy in Dif¬ 
ferent Food Materials at Average Prices {Continued): 

(It is estimated that a man at light to moderate muscular work requires about 
0.23 pound of protein and 3050 calories of energy per day.) 


Kind of food material. 

Price per pound. 

Cost of 1 pound 
protein. 1 

Cost of 1000 calor¬ 

ies energy. 1 

Total weight of 

food material. 

V.mour 

0 

•pH 

o> 

o 

H 

Ph 

its for 

a 

10 cen 

CO 

s 

■u 

cS 

'O 

A 

o 

A 

s_ 

6 

CO 

Energy. 


Cts. 

Dolls. 

Cts. 

Pds. 

Pd. 

Pd. 

Pds. 

Cals. 

Pork, fat salt. 

12 

6.67 

3 

.83 

.02 

.68 


2950 

Codfish, dressed, fresh . . . 

10 

.93 

46 

1.00 

.11 



220 

Halibut, fresh. 

18 

1.22 

38 

.56 

.08 

.02 


265 

Cod, salt. 

7 

.45 

22 

1.43 

.22 

.01 


465 

Mackerel, salt, dressed . . . 

10 

.74 

9 

1.00 

.13 

.20 


1135 

Salmon, canned. 

12 

.57 

13 

.83 

.18 

.10 


760 

Oysters, solids, 50 cts. per qt. 

25 

4.30 

111 

.40 

.02 

. . 

.01 

90 

“ “ 35 

18 

3.10 

80 

.56 

.03 

.01 

.02 

125 

Lobster, canned. 

18 

1.02 

46 

.56 

.10 

.01 


225 

Butter. 

20 

20.00 

6 

.50 

.01 

.40 


1705 

U 

25 

25.00 

7 

.40 


.32 


1365 

U 

30 

30.00 

9 

.33 


.27 


1125 

Eggs, 36 cents per dozen . . 

24 

2.09 

39 

.42 

.05 

.04 


260 

“ 24 “ “ 

16 

1.39 

26 

.63 

.07 

.06 


385 

« 12 •« « 

8 

.70 

13 

1.25 

.14 

.11 


770 

Cheese. 

16 

.64 

8 

.63 

.16 

.20 

.02 

1185 

Milk, 7 cents per quart. . . 

zy n 

1.09 

11 

2.85 

.09 

.11 

.14 

885 

“ 6 “ “ ... 

3 

.94 

10 

3.33 

.11 

.13 

.17 

1030 

Wheat flour. 

3 

.31 

2 

3.33 

.32 

.03 

2.45 

5440 

it it 

2M 

.26 

2 

4.00 

.39 

.04 

2.94 

6540 

Cornmeal, granular .... 

2 l A 

.32 

2 

4.00 

.31 

.07 

2.96 

6540 

Wheat breakfast food . . . 

7 1 /! 

.73 

4 

1.33 

.13 

.02 

.98 

2235 

Oat breakfast food. 

l l A 

.53 

4 

1.33 

.19 

.09 

.86 

2395 

Oatmeal. 

4 

.29 

2 

2.50 

.34 

.16 

1.66 

4500 

Rice. 

8 

1.18 

5 

1.25 

.08 


.97 

2025 

Wheat bread. 

6 

.77 

5 

1.67 

.13 

.02 

.87 

2000 

it ti 

5 

.64 

4 

2.00 

.16 

.02 

1.04 

2400 

it it 

4 

.51 

3 

2.50 

.20 

.03 

1.30 

3000 

Rye bread. 

5 

.65 

4 

2.00 

.15 

.01 

1.04 

2340 

Beans, white, dried .... 

5 

.29 

3 

2.00 

.35 

.03 

1.16 

3040 

Cabbage . . 

2'A 

2.08 

22 

4.00 

.05 

.01 

.18 

460 

Celery . 

5 

6.65 

77 

2.00 

.02 

. . 

.05 

130 

Corn,canned . 

10 

4.21 

23 

1.00 

.02 

.01 

.18 

430 

Potatoes, 90 cents per bushel. 

iy 

1.00 

5 

6.67 

.10 

.01 

.93 

1970 

“ 60 “ 

i 

.67 

3 

10.00 

.15 

.01 

1.40 

2950 

tt a a 

% 

.50 

3 

13.33 

.20 

.01 

1.87 

3935 

Turnips. 

i 

1.33 

8 

10.00 

.08 

.01 

.54 

1200 

Apples. 

iy 

500 

8 

6.67 

.02 

.02 

.65 

1270 

Bananas . 

7 

10.00 

27 

1.43 

.01 

.01 

.18 

370 

Oranges. 

6 

12.00 

40 

1.67 

.01 

. . 

.13 

250 

Strawberries. 

7 

8.75 

47 

1.43 

.01 

.01 

.09 

215 

Sugar. 

6 

• • 

3 

1.67 

• • 

. . 

1.67 

2920 


1 See foot-note, page 368. 


24 



















































370 


DIETETICS 


PECUNIARY ECONOMY OF MILK AND OTHER FOODS. 
Amount* of actual nutrients obtained in different food materials for ten cent*. 

Protein. Fat Carbohydrates Fuel value. 


Pood material. 

Ten 

cents 

will 

bny— 

Pounds of nutrients and calories in ten cents’ worth. 

L 



ba.Oz. ‘ 

~ fOOOcal ZOOOccil. 3000cal. 4000c*l 

Whole milk, 10 
«ta. per q*-- 



9 0 


Whole milk, 8 
eta. per qt- 





Whole milk, 7 
cte. per qt. 


mmm 



Whole milk, 6 
cte. per qt. 





Whole milk, 5 
cte. per qt- 


MF=mm 1 

4 0 


Whole milk, 4 
cts. per qt- 

6 0 

nr wwflk 


Skim milk, 3 eta. 
perqt. 



6 n 


Skim milk, 2 cte. 
per qt. 

10 0 



Better, 24 cte. 

0 7 





Cheese, 16 cte. 
per lb- 

0 10 



Beef, round, 12 
cte. per lb. 

0 13 

MM 


Beef, sirloin, 18 
cts. per lb. 

0 0 


mmmm— 

Mutton, loin, 16 
cte. per lb. 

0 10 


—— 

Pork,»lt,12cte. 

0 13 

ft, ...... - 



-Cod, salt, 6 cts. 
per lb.. 

i e 



Eggs, 28 cts. per 
doz. 

0 11 


i 

Oysters, 30 cts. 
per <lt. 

0 11 

m 


Potatoes, 60 cte. 
per bu. 

10 0 

msMMMMmmmmmmm 


Beans, dried, 8 
eta par qt.... 

t 8 



Wheat flour, 8 
cte. per U>-... 

. 8 5 








From Bulletin 74, United States Department of Agriculture. 



























































































PRINCIPLES OF COOKING 


*371 


CHAPTER XL 


PRINCIPLES OF COOKING 


The manner in which food is cooked and served has 
much to do with its digestibility and nutritive value. 

The objects of cooking may be summed up as follows: 

1. To make food more appetizing by improving the 
appearance and flavor. Almost all flesh foods and many 
vegetables are unpalatable in their raw state. The effect 
of a high temperature on them develops agreeable proper¬ 
ties which are absent in the uncooked state, and increases 
the appetite for food. 

2. To soften and otherwise change the structure of the 
food so that the digestive juices can act on it more easily. 
The heating of food enables it to become more easily masti¬ 
cated. In animal foods the muscular fibers lose much of 
the toughness shown in the raw state and are more readily 
divided, and the same is true of many vegetable foods. 

3. To kill by heat disease germs or any injurious organ¬ 
isms which the food may contain. The heat acts as a 
preservative from putrefactive changes. At the same 
time it affords a safeguard to the individual. Both food 
and drink, in their raw state, may become carriers of 
disease into the system. Animal foods may contain in¬ 
jurious parasites. Vegetables and fruits may be con¬ 
taminated with the eggs of various parasites found in the 
fertilizing material applied to promote growth. Exposure 
to heat for a short time is sufficient to render most foods 
safe in this respect. 

Methods of Cooking.—Cooking is accomplished by 
several different processes. The varying of the methods 
of cooking prevents monotony, increases the appetite, and 
in different ways aids digestion: 


1. Boiling. 

2. Stewing. 

3. Roasting. 


5. Frying. 

6. Braizing. 

7. Baking. 

8. Steaming. 


4. Broiling or grilling. 


DIETETICS 


372 

Cooking of Flesh Foods .—All meats and fish lose weight 
in cooking. A part that is lost consists of salts, meat 
juices, and fats, but most of the loss is water. 

Boiling .—If the purpose in boiling the meat is to pre¬ 
pare it for use as food, it should be plunged into boiling 
water and kept boiling for five minutes to coagulate the 
albumin on the outside, and form a coating that will pre¬ 
vent the escape of salts and soluble substances. There is 
no object in trying to increase the heat after the boiling- 
point has been reached. A temperature of 170 1. is 

sufficient to continue the cooking by this method. Rapid 
boiling tends to make the meat tough, dry, and less easily 
digested than if cooked by a slow, simmering process. 

If the object in cooking the meat is to extract as much 
of its substance as possible for use as broth or soup, it 
should be placed in cold water and gradually heated. By 
this method the salts, juices, and soluble portions of the 

meat pass out into-the water. 

Broth is rendered still more nutritious if the meat is 
cut into very small pieces, put into cold water, and never 
actually brought to the boiling-point. If the temperature 
does not exceed 160° F., coagulation of the albumin in the 
muscle-fibers does not occur and more of the constituents 
are dissolved in the water. This method preserves the 
natural flavor. 

Stewing prepares the meat to be eaten in the liquid in 
which it has been cooked. This slow method is specially 
suitable for coarse, cheap parts of meat. The usual plan 
is to add sliced vegetables and other substances. The 
meat is put on in a small amount of cold water, allowed 
to boil rapidly not longer than two minutes, and the cook¬ 
ing continued at a lower temperature. A temperature of 
about 160° F. is considered sufficient for simmering. 
From one and one-half to two hours is required and a 
longer time is desirable. 

Roasting is cooking by the direct action of radiant heat. 
By this method the nutritive juices and properties of the 
meat are retained more completely than by boiling. The 


PRINCIPLES OF COOKING 


373 


meat to be cooked should be at first subjected to a strong 
heat and afterward cooked very slowly. The effect of 
this method is to form a surface crust, which prevents the 
escape of the soluble parts of the meat to a large degree. 

Basting with the melted fat and water is important. It 
prevents too much of the surface becoming hardened, 
prevents scorching, distributes the heat more uniformly, 
and improves the flavor of the meat. Only a good quality 
of meat, and the tenderest parts, are suitable for cooking 
by roasting. 

The time needed varies with the different kinds of meats. 
Pork requires longer roasting than beef. Thick pieces 
require longer than thin ones, and, lastly, the individual 
taste must be consulted as to whether the meat shall 
be underdone, medium, or well cooked. A general rule 
is to allow about fifteen minutes as the shortest time and 
thirty minutes as the longest time required for each pound 
of meat to be roasted. The same rule will apply for boil¬ 
ing. If moderate heat only is applied at first, the meat 
will be dry and stringy, and no amount of basting or 
attention afterward will hinder the result of this error in 
roasting. 

Broiling or grilling is cooking by the direct action of 
fire close to the surface of the meat. The outer layer is 
quickly seared and a coating formed, which prevents the 
escape of the juices. Broiling requires a clear, very hot 
fire high in the grate, preferably a coal fire. The meat 
needs to be turned very frequently. A double gridiron 
is best for this purpose. If this is not available, a knife 
should be used for turning instead of a fork, which will 
puncture the meat and let the juice escape. Frequent 
turning has much to do with successful broiling. If this 
is not done, the juices will be driven upward to the surface 
and lost. Unnecessary drying of the surface is prevented 
by smearing with butter or fat before cooking. This 
method is regarded as probably the most wholesome of 
all methods of cooking meat, but it requires experience 
and careful watching for signs if a successful result is to 


374 


DIETETICS 


follow. It is only suitable for thin pieces of meat, such as 
steaks and chops, and only meat of a good quality should 
be prepared in this way. One of the signs that broiled 
meat is cooked is a lessening of the puffiness which appears 
as the result of the first contact with the heat. Broiled 
meat should be moist, red, and very juicy. Overcooking 

destroys the flavor. , 

Poultry, small birds, and some kinds of fish may be 
successfully prepared by broiling. As birds, as a rule, have 
but little natural fat, they are generally encased in still 
paper, thoroughly greased, before being exposed to the 
heat, to prevent drying. This method has the advantage 
of being rapid and convenient. The principle of cooking 
is similar to roasting, but a far larger surface is exposed 
at once to the direct action of a strong heat. 

Braizing is a combination of roasting and steaming. 
Meat cooked in this way is popularly termed “ pot-roast. 

A regular braizing pot consists of a deep pot or pan to 
hold the meat and a shallower pan for the tight lid, into 
which hot charcoal is placed. A small amount of water 
and, usually, some savory vegetables or herbs are placed 
in the braizing pot and the meat laid on them. Only 
sufficient water is used to keep the meat from burning 
and to generate the steam. The cooking should proceed 
very slowly, and the meat should be turned several times. 
Usually this method is accomplished by using a common 
heavy iron pot and a tight cover. If the meat is not suffi¬ 
ciently browned, it can be put for a few minutes in a hot 
oven at the close of the cooking. This manner of cooking 
is suitable for quite large solid pieces of meat. The cheaper 
cuts of beef are often prepared in this way to be eaten 
cold. Flavor and moisture are imparted to inferior pieces 

of meat by braizing. , , . 

Frying consists in exposing food to the action ot tat at 
a very high temperature. The boiling-point of fat is much 
higher than of water, and a temperature of about 380 F. 
is required. Two methods of frying, the wet and the dry, 
are practised. Wet frying requires a deep vessel and 


PRINCIPLES OF COOKING 


375 


enough fat or oil to completely cover the article to be 
cooked in it. The heat of the fat before the food is put 
in is very important. It should be hot enough for a piece 
of white bread put in it quickly to turn to a golden color. 
Usually when this degree of heat is reached, a bluish vapor 
will rise from the fat. Most foods to be cooked in this 
way require to be smeared with some substance that will 
quickly form a crust when heated; usually egg or butter 
are used. This coating or crust prevents the fat penetrat¬ 
ing into the food, and also the flavor of the food escaping 
into the fat. This method of frying is much to be pre¬ 
ferred to the dry method, known as “sauteing.” In the 
dry method less fat is needed, but the flavors of the food 
escape and the fat permeates the substance fried, making 
it very difficult of digestion for any but persons with 
a very strong, robust stomach. It should never be used 
in cooking for invalids or any individual with poor digest¬ 
ive powers. An exception to this rule is bacon, which is 
fried in its own fat. It is stated by food experts that the 
art of frying is less understood than any other method of 
cooking. As generally conducted, frying is a kind of acci¬ 
dental combination of broiling and toasting. The result 
is that fried food, as it is usually cooked, is notoriously 
indigestible. 

Fish may be cooked by boiling, grilling, or frying. 
Boiled fish are most easily digested. The boiling should 
be continued till the meat can be readily separated from 
the bones. A little salt in the water improves the flavor 
and makes the meat firmer. 

It should always be remembered that extreme heat 
tends to harden the lean portions of meat and weakens 
or impairs the flavor. Proper cooking develops the agree¬ 
able flavor, softens the tissues, and makes the meat more 
tender. 

SOUPS 

Soups may be divided into four classes: Broths, thick 
soups, purees, and clear soups. The base of a great many 
soups is stock. 


376 


dietetics 


Stock may be made from meat or bones with water. 
Vegetables may be added for flavoring if it seems desirable, 
but unless the flavor of a special vegetable is desired, the 
common vegetables such as onion, carrot, turnip, parsley, 
etc., may be used in equal proportions. Dried herbs used 
for flavoring should be tied in muslin. 

If dark soups are desired, the meat may be seared on a 
hot pan before boiling, but this is rarely necessary for 

invalids. , 

Salt added to the water helps to extract the juices from 

Second stock is often made from the materials strained 
out of the first, with perhaps bones of cooked meats and 

gravy added. , , 

Veal produces a whitish stock; beef, a stock more or less 
brown. The chief secret of good stock making is slow 

Fish^stock is sometimes made from white fish, the bones, 
skin, etc., being used with savory vegetables for seasoning. 
More water is used in making fish stock, as the flavor is 

stronger. , 

A pint of water for each pound of meat or bone, and one 
additional pint for evaporation, is a good rule for making 

Broth or bouillon is unclarified stock, in which vegetables 
or some special substance have been used for flavoring. 
Bouillon is usually of a dark color. _ . 

Thick soup is stock thickened by the addition of some 
starchy substance or eggs. 

Purges are thick vegetable soups. The vegetables are 
pressed through a sieve and mixed with the soup. Purees 
may or may not be made from meat stock. Very fre¬ 
quently milk is used instead of stock. 

Clear soup or consomm6 is stock made from good meat, 
usually with some special flavor, and freed from everything 
that would make it cloudy. In all soup making, skimming 
away the froth or scum that arises is an important point. 


PRINCIPLES OF COOKING 


377 


COOKING OF STARCHY FOODS AND VEGETABLES 

The effect of heat on vegetable substances is similar to 
that produced on flesh foods. The structures are softened 
and made ready for mastication and digestion. 

Starch Granules .—The principal nutritive element in 
vegetable substances is starch. The microscopic starch 
grains are contained in very minute cells. These cell 
walls are thick and digestive juices have little effect on 
them. The chief effect of heat is to rupture the cell wall 
or outer envelope, in which are the starch granules, leaving 
the starch in a condition to be easily and promptly acted 
on by the saliva, and other starch-digesting fluids. A por¬ 
tion of the starch is converted into sugar by heat. On the 
albuminous substances of vegetables heat has the same 
effect as on animal tissues. In various ways it produces 
desirable flavors in food exposed to it. 

In making bread and other foods in which flour is the 
chief ingredient, the aim is to make a firm, porous sub¬ 
stance which can be readily masticated and more easily 
permeated with the digestive juices than the raw materials 
could be. The flour is made porous by the addition of 
water, some form of leaven, and a certain degree of heat. 
In a short time the mass begins to swell or “rise,” and 
while active fermentation is going on the sponge is kneaded 
and again allowed to rise. If sufficient fermentation is 
not allowed, a heavy loaf is the result. If fermentation 
proceeds too far before being checked by extreme heat, 
a different form of fermentation starts, which is acid in 
character, and the result is sour bread. 

Yeast is a vegetable organism, which, like the bacteria, 
lives and grows when provided with suitable nourishment, 
warmth, and moisture. 

Extreme heat kills the yeast when fermentation has 
proceeded far enough. 

Baking powder when mixed into flour and water causes 
the mass to become porous by producing carbonic acid 
gas. Aerated bread is made by forcing carbonic acid gas 
into the dough under pressure. 


378 


DIETETICS 


Steaming of vegetables prevents loss of various salts, 
and is a desirable method of cooking potatoes, rice, and a 
few other vegetables. The steaming of doughy substances 
renders them stringy, tough, and less easily digested than 
baking. It is, therefore, not a desirable method of cooking 
such foods for invalids. 


CHAPTER XLI 
MILK 

The percentage composition of good cows milk is thus 
given by Parkes: 

Specific Gravity, 1029 and Over 

Water. 86.8 

Protein. 

Fats. 3.7 

Carbohydrates. 

Salts...'. 07 

Milk has been termed a perfect or complete food because 
it contains all the elements needed for the nourishment of 
the body. It is a perfect food for infants or the young of 
milk-producing animals, but it does not fully meet the 
conditions of a perfect food outlined in a previous chapter. 
There are three reasons why it cannot be considered a 
perfect food for healthy adults, though it has special value 
as a food for invalids, and life can be supported for a con¬ 
siderable time on milk without other foods: 

1. The proportion of water is so large that large quan¬ 
tities would have to be consumed per day in order to obtain 
the necessary nutrients. 

2. The protein is present in rather large quantities as 
compared with the fats and carbohydrates. 

3. The digestive functions require that the food shall 
have a certain bulk other than water. 1 

1 Bulletin 74, United States Department of Agriculture. 








MILK 


379 


Milk as a Food for Invalids. —There are several 
reasons why milk is considered of special value in sick¬ 
ness: 

It is easily digested and capable of almost complete 
absorption. 

It does not irritate the alimentary tract and leaves no 
coarse residue in the intestine. 

It is more easily measured and controlled, both as to 
quantity and quality, than most other foods. 

Added to these reasons are the facts that it is com¬ 
paratively cheap and easily procured. 

Nutritive Value. —It is said that 1 quart of milk con¬ 
tains about the same amount of nutritive material as 
J pound of beef or 6 ounces of bread, or about 4 ounces. 
There is, however, considerable variation in the nutritive 
material in different specimens of milk, due to the food 
supplied to the cow, to the age, and other conditions. 

The habit of excessive drinking of milk by active per¬ 
sons in good health who are taking solid food is con¬ 
demned by the bost authorities as conducive to consti¬ 
pation, dyspepsia, and torpidity of the liver. As a food 
for the young and the aged, when solid food is not well 
digested, it has a special value. The reason why milk 
so frequently disagrees when taken as an exclusive diet 
is said to be that it contains too much of the nitrogenous 
element as compared with the carbohydrates. 

Bacteria in Milk. —The souring of milk is due to the 
presence in it of bacteria, which act on the sugar, changing 
it into lactic acid. The casein becomes coagulated by 
the acid produced. Sour milk is not necessarily unwhole¬ 
some, but it should always be remembered that milk is an 
excellent food for both good and bad germs. It has been 
found that disease germs that would soon die in water 
will grow and multiply rapidly in milk. This has led to 
rigid precautions on the part of public health authorities 
regarding the care of milk, since in careless transportation 
and handling, germs of all kinds are readily absorbed and 
transmitted. 


380 


DIETETICS 


Skimmed milk, or milk from which the cream has been 
taken away, is still a valuable food, since only the fat has 
been removed. It still contains the tissue-building in¬ 
gredients. 

Cream is chiefly valuable for its heat-giving properties, 
and the same is true of butter. These are the most agree¬ 
able and easily digested of all animal fats. 

Buttermilk furnishes more nutriment than most other 
beverages, and is practically equal in food value to skimmed 
milk. “ An ordinary glass of buttermilk is said to contain 
as much nourishment as 4 pint of oysters, or 2 ounces 
of bread, or a good-sized potato .” It is a much more 
agreeable food to many people than either whole or 
skimmed milk, and is largely used in cases of feeble di¬ 
gestion because of the ease with which it is digested. 

Curds and Whey.—When an acid or rennet is added 
to milk, the casein, the solid portion and the chief nitrogen¬ 
ous element of milk, coagulates and forms the curd. The 
fluid from which it separates is the whey. The curd, which 
is frequently used as food in the form of i( cottage cheese, 
is rich in tissue-building elements and easily digested as 
compared with other solid foods. 

The whey contains little nutritive material, but is a 
useful diuretic beverage. There are special methods of 
preparing whey, especially for infants and invalids, by 
which a considerable portion of the nutritive elements 
are retained. 

Cheese contains the casein or curd of the milk with 
a certain proportion of the fat. It contains, weight for 
weight, twice as much nutriment as meat. The special 
flavors produced are the result of different forms of bac¬ 
teria. Cheese is usually regarded as difficult to digest, 
and if given to invalids should be given in small quan¬ 
tities, rather as a condiment than as a food. 

Milk-sugar lacks the sweetness of other sugar, and is 
much less liable to cause disagreeable fermentation in 
the stomach or intestines. It resembles powdered sugar 
in appearance. It is considered particularly suitable 


MILK 


381 


for infants, and is extensively used in the manufacture of 
pills. 

Effects of Heat on Milk. —Milk is sterilized by bring¬ 
ing it to the bciling-point (212° F.). 

Pasteurization of milk is accomplished by exposing 
it to heat for twenty minutes at 167° F. It is said to be 
more easily digested than milk which has been sterilized, 
but there is much conflicting testimony offered regarding 
this matter. A great many authorities claim that not 
only is sterilized milk more difficult to digest than raw 
milk, but that certain of its nutritive elements are de¬ 
stroyed. Heat has the effect of destroying the injurious 
germs present, and this seems to be quite sufficiently ac¬ 
complished by pasteurization. 

Modified milk is a term applied to cows’ milk which 
has been modified or changed in character and adapted 
for the use of infants and invalids. The particular 
methods used in preparing milk for infants will be dis¬ 
cussed in connection with the care of infants in a succeed¬ 
ing volume of studies. The methods of altering milk 
for the use of invalids must be, to a large extent, governed 
by the tastes, and general condition of the individuals. 
Much care and good judgment must be exercised by the 
nurse in administering milk, especially when it forms 
the sole or the chief article of diet. 

Digestion of Milk. —Milk, though it is a fluid outside 
the body, is quickly curdled and turned into a solid by 
the action of pepsin and the acid fluids of the stomach. 
When milk is taken without other foods, the casein is liable 
to gather in hard lumps or curds which are difficult to 
digest. Human milk, when taken into the stomach of 
an infant, is not precipitated in such large lumps, but is 
more flaky, and, therefore, more easily acted on by the 
digestive fluids. It is said that the boiling of cows’ milk 
tends to make the curds formed from it by the stomach 
juices more flaky in character. Many authorities state 
that lime tends to prevent the casein forming in hard 
indigestible lumps by neutralizing the acids, and also by 


382 


DIETETICS 


its own property of retarding coagulation. For this 
reason lime-water is often added to the milk fed to infants 
and invalids who have feeble digestive powers. 

The Administration of Milk. —The proper manage¬ 
ment of a milk-diet calls for skill and intelligence. It is 
not sufficient simply to carry a stipulated amount of 
milk to a patient and let him swallow it as rapidly as 
possible, as he would a nauseous dose of medicine. There 
is no better way to make sure that it will disagree. One 
of the first lessons the nurse should teach her patient is 
how to drink milk. It should be sipped slowly, that it 
may become thoroughly mingled with the saliva. In 
fact, it should always be remembered that milk is a food 
which should be eaten rather than drunk. When thus 
used it is not likely to form into tough, indigestible 
masses in the stomach, that cause distress, are rejected, 
or pass through the bowel undigested. 

In certain fevers or other acute^ ailments, when the 
patient objects to milk and there is a probability of the 
milk or fluid diet having to be long continued, it is well 
to start by giving but 1 ounce or even % ounce at a time, 
giving it either ice cold or very hot, and repeating every 
fifteen minutes for a few hours, until the patient learns 
that it does not disagree with him. Then the quantity 
may be increased. 

Whenever there is a tendency for milk to disagree, other 
substances, such as chicken broth or whisky, should not 
be combined. Milk should never be given at or near the 
same time with medicines. 

One of the very best ways of administering milk is in 
the form of junket, flavored with some substance which 
the patient likes. Junket is really milk which is partly 
digested by the action of rennet. Very often a patient 
may be beguiled in this way into taking milk, because 
it looks different and can be eaten with a spoon. It is 
an excellent method of varying the monotony of a purely 
milk-diet. 

A very smooth, bland, easily digested custard may be 


MILK 


383 


made with milk and gelatin, suitably flavored, which 
makes an agreeable change in a purely milk-diet. 

Where there is an objection to animal broths, a very 
agreeable, nourishing drink may be made of equal parts 
of strong chicken broth and milk, heated to a boiling- 
point. 

Another combination that appeals to lovers of coffee 
is the addition of a tablespoonful of strong black coffee 
to 4 or 5 ounces of milk, served hot. Other patients may 
prefer the tea or cocoa flavor, and, at other times, vege¬ 
table flavors, such as celery or tomato, may be used. 
Where starchy substances are not forbidden, milk may be 
given with strained cereal gruels, both for variety and to 
improve its digestibility. Unless the condition of the 
stomach forbids, it will generally be found that milk is 
less likely to disagree if a cracker, small piece of bread, 
or some starchy substance is given with it. This is par¬ 
ticularly true where children are concerned. 

Diluting milk with very hot or very cold water makes 
it more easily digested in many cases, and Vichy or similar 
waters are often used. 

Barley-water is recommended frequently in diluting 
milk in cases of diarrhea, and oatmeal-water where 
constipation exists; It is well to remember that where 
a tendency to constipation exists, the use of lime-water 
exaggerates the difficulty, while it is a decided help in 
dealing with diarrhea or nausea. 

Predigestion of milk is accomplished by the addition 
of pepsin or pancreatin to the milk before it enters the 
body. By this means the alimentary system is relieved 
of part of its work, and a portion of the digestion com¬ 
pleted before the milk is taken. 

A government bulletin 1 gives the following two tables, 
which show that a meal of bread and skimmed milk, cost¬ 
ing 4 cents, contained as much nutritive material as a 
15-cent lunch containing nine different food materials: 

1 Bulletin, No. 74. 


384 


DIETETICS 


Composition and Cost of a Lunch or Meal of Biead and 
Shimmed Milk 


Food materials. 

Amount. 

Estimated 

cost. 

Protein. 

Fuel 

value. 

Bread. 

Skimmed milk. 

10 oz. 
lpt. 

Cents. 

3 

1 

Pound. 

0.06 

.03 

Calories. 

755 

170 

Total. 


4 

.09 

925 


Estimated Cost and Nutrients of a Restaurant Lunch 


Food materials. 

Amount. 

Estimated 

cost. 

Protein. 

Fuel 

value. 

Soup.. 

Beef. 

Potatoes. 

Turnips. 

Bread. 

Butter. 

Coffee: 

Milk. 

Sugar. 

Ounces. 

8 

2 

2 

1 

4 

X A 

l 

Cents. 

Pound. 

0.01 

.02 

' .02’ 

Calories. 

75 

275 

100 

15 

300 

100 

20 

55 

Total. 


15 to 20 

.05 

940 


CHAPTER XLII 

EGGS AND FLESH FOODS 
EGGS 

Eggs supply a highly nutritious food in concentrated 
form. The}' are like milk, in that they contain all the 
elements found in the animal body. Out of the egg the 
entire structure of the bird—bones, muscle, nerves, etc., 
even feathers, in some cases—is developed. In this devel¬ 
opment the shell is included, since it contains elements 
necessary to the life of the bird. 

Hens’ eggs are chiefly used as food, though occasionally 
those of other domestic fowls are eaten. The ingredients 
are practically the same, but the quality and flavor are 











































EGGS AND FLESH FOODS 


385 


peculiar to different birds. The flavor is also, to some 
extent, dependent on the food of the hen. The shell of 
the egg is not impervious. It will absorb strong odors, 
and bacteria may penetrate the shell and effect decom¬ 
position. The shell is chiefly composed of carbonate 
of lime. 

The yolk contains about 15 per cent, of proteid matter, 
33 per cent, of fat, with water and other mineral elements. 
The white contains slightly less proteid and almost no 
fat. The yolk contains more nutriment than the white, 
which is mostly albumin in solution. 

^88® form an easily digested food if taken raw or very 
lightly cooked, and are, therefore, especially suitable for 
invalids. In the intestines, if absorption of eggs is long 
delayed, a peculiar form of decomposition results, due 
chiefly to the yolk of the egg. This may cause disorder 
of the stomach and intestines. It is exceedingly import¬ 
ant in giving eggs to patients in whom those organs are 
deranged to have them “strictly fresh ” if possible. Owing 
to idiosyncrasy some persons are unable to take eggs in 
any form, or in the smallest amount, without the develop¬ 
ment of toxic symptoms, illustrating the undoubted truth 
that “one man’s meat is another’s poison.” Different 
individuals are quite differently constituted regarding 
the chemical changes which foods taken into the system 
undergo and in the effects produced by foods. There is 
probably no other common article of food about which 
invalids are as capricious regarding cooking as eggs. 
The albumen coagulates at a temperature of 158° F. 
Rapid boiling renders it tough, and a little carelessness 
about cooking and serving an egg makes the difference 
between easy and difficult digestion, between a palatable 
and an insipid, disagreeable article. 

When eggs are beaten to a stiff froth for cooking, the 
albumen encloses air in bubbles, which expand and stiffen 
when exposed to heat and mixed with dough or batter, 
making the food light and spongy. This quality of frothi¬ 
ness is lost when eggs are kept for a long time before using. 

25 


386 


dietetics 


A medical authority on dietetics states that there are five 
hundred different ways of cooking eggs, and every nurse 
ought to be familiar with at least a dozen different methods 
of preparing eggs for the use of invalids. 

MEATS 

The value of meat as an article of diet depends on the 
two classes of nutritive elements, protein and fats. . 

Advantages of Meats as Food. —The fact that anima 
foods contain precisely the same elements as the human 
body is considered a strong point in favor of their use. 

1 ‘ They are rich in nitrogenous elements and lat. 

“They are more easily and completely digested and 

assimilated than vegetable foods. . 

“ They are easily cooked and improve in flavor during 

“They contain important salts, chiefly potassium and 

'^Disadvantages of Meat.— While animal foods seem 
exceedingly well adapted for maintaining the body and 
building new tissue, they are not valuable for producing 
force or energy. Their disadvantage is in the absence ot 
starch. This disadvantage is less where there is a con¬ 
siderable proportion of fat with the meat. 

Composition and Digestibility of Meat. Digesti¬ 
bility is influenced by many conditions, including the age 
of the animal before slaughtering, the sex, the state of 
nutrition, the part of the body used, etc. Fat meat is 
more difficult to digest than lean. Meat from young ani¬ 
mals contains more gelatin, but less nutritive elements, 
on the whole, and a larger relative proportion of bone. 

Meat consists of lean or muscular tissue, gristle, tatty 
tissue, blood-vessels, nerves, and bones. The amount of 
each of these substances varies with different cuts of meat, 
and with other conditions. . 

Beef is one of the most nutritious of all animal foods, 
and when properly cooked, is fairly easily digested. 

Quality .—The first quality of meat includes rump, sir¬ 
loin, and fore-ribs. 


EGGS AND FLESH FOODS 387 

The second quality includes a portion of shoulder, but¬ 
tock, middle rib, etc. 

The third quality includes the flank, shoulder, and 
brisket. 

The fourth quality includes cheek, neck, and shin. 

Veal has the reputation of being less easily digested 
than beef or mutton. It contains more gelatin than beef, 
but is not regarded as having any special value for the 
use of the sick. 

Mutton is richer in fat than beef, is less easily digested, 
and contains equal nutritive value. 

Pork is a tender-fibered meat, but because of the high 
percentage of fat is considered a highly indigestible food. 

Ham may contain little fat, and is, therefore, not open 
to this objection. 

Bacon is said to be less likely to disagree with the stom¬ 
ach than the other fat of pork, and, when combined with 
eggs, beans, and other articles containing much nitrogen, 
helps to give a proper balance to the dietary. 

Sweetbread is a meat delicacy that is considered a 
useful food for convalescents. There are two kinds, one 
consisting of the pancreas of the calf, frequently called 
“stomach sweetbread,” and, the other of the thymus 
gland of the same animal, distinguished by the term 
“neck” or “throat” sweetbread. The latter is con¬ 
sidered somewhat more easily digested than the former, 
but both are easily digested meats. 

Liver. —The liver of the pig, calf, and lamb are used 
as human food. The meat is rich and close of texture, 
and suitable only for persons with good digestive powers. 
The same is true of kidneys and heart. 

Tripe consists of the paunch or third stomach of the 
ox. It is considered to be comparatively easy of digestion 
when well cooked, but contains too much fat to make it 
a desirable food for invalids. 

Rennet is a preparation obtained from the stomach 
of the calf. It is not used separately as a food, but is used 
in milk to a considerable extent. It causes milk to curdle 


dietetics 


388 

and partially solidify. It is used in preparing junket, and 

sometimes, whey. . . 

Brains are easily digested, but have little nutritive 
value. Because of the amount of fat they are considered 

unsuitable as a food for the sick. 

The thyroid gland is sometimes cooked and eaten as 
food in cases of myxedema and chronic skin disease. As 
a rule, it is given dried in moderate doses as a medicine 

rather than as a food. . , 

Gelatin is a by-product of the slaughter-house obtained 
from bones, ligaments, and other connective tissue o 
animals. Before being purified it is known as glue, it 
enters considerably into the composition of soup where 
much bone is used, and is extensively used in making 
jellies and other forms of light diet for invalids. It has 
also varied uses in the preparation of medicines. 

Gelatin does not build up tissue nor produce force. Its 
chief use is as a preventive of waste of tissue. Bor this 
reason it has considerable value as a fo °d in fevers that 
are accompanied by much loss of flesh. When combined 
with other foods, gelatin promotes nutrition and is easily 

digested and absorbed. , a , 

Calf’s foot and head jellies are easily prepared forms of 
gelatinous foods, and, when properly flavored are useful 
in the invalid’s dietary. These need several hours boil¬ 
ing. Though the amount of real nourishment in such 
jellies is small, and they should not be used instead of 
albuminous foods, yet, because they do save waste of 
tissue, they hold a place of some importance among foods 

for invalids. , , . . M 

Poultry and Game.— Chicken ranks high among easily 
digested foods. The dark meat is rather more difficult 
to digest than the white. When used for broths and 
jelly an old fowl, not too fat, is preferable. When the 
meat of the chicken is the substance required, a fowl 
from one to two years old is desirable. The proportion 
of bone to meat in chickens under that age makes them 

an expensive article of diet. . ,,, , 

The flesh of game has slightly less fat than that oi 


EGGS AND FLESH FOODS 


389 


poultry and a finer flavor. Snipe, quail, and woodcock 
are too rich foods for the average invalid. Pheasant, 
partridge, and young pigeons are tender, delicate in flavor, 
and easy of digestion. 

Turkey, especially the white meat, is a meat almost as 
easily digested as chicken. 

Ducks and geese contain much fat and, unless quite 
young, are somewhat difficult of digestion. 

FISH 

The term fish includes, besides fish proper, other water 
animals, such as oysters, clams, crabs, lobsters, etc. 

Fish helps to supply the nitrogenous element needed 
in the diet and to meet the demand for variety. The 
different varieties differ greatly in nutritive value, in 
flavor, and also in digestibility, owing largely to the pro¬ 
portion of fat. Salmon is considered richer in nutritive 
elements than most other varieties of fish, and the oily 
or coarser grained species more nutritious than the white 
or finer grained, although the latter have the more delicate 
flavor and are easier of digestion. A government bulletin 
divides fish into three classes, according to the proportion 
of fat: The first class (fish containing over 5 per cent, 
of fat) includes salmon, shad, herring, and Spanish mack¬ 
erel. The second class (fish containing between 2 and 5 
per cent, of fat) includes white fish, mackerel, and hali¬ 
but. The third class (fish containing 2 per cent, of fat) 
includes smelt, black bass, blue fish, white perch, brook 
trout, yellow perch, pike, pickerel, sea bass, cod, and 
haddock. In general, it may be said that all fish having 
white meat deserve a place in the invalid’s diet. 

Shell fish resemble meat and other fish in general food 
elements. 

Oysters are probably the most important of the shell 
fish, judging by the amount used. Taking cost and 
nutritive value into consideration, they are a highly ex¬ 
pensive food. Authorities state that 1 quart of oysters 
contains only about the same amount of nutritive sub¬ 
stance as 1 quart of milk. Oyster stew or oyster broth 


390 


DIETETICS 


owes its nourishing qualities more to the milk used in its 
preparation than to the oysters it contains. In regard 
to digestibility, raw oysters rank first or almost first among 
flesh foods. 

Oysters which have been “floated” in brackish water 
near the mouth of a stream are frequently infected by 
disease germs carried into the stream from the sewage. 
Numerous cases of typhoid fever have been traced to this 
cause. 

Clams are useful in the invalid’s diet chiefly for broths. 
Plain clam broth is especially valuable in cases of vomiting 
and nausea, and will often be retained when all other food 
is rejected. It has slight nutritive value and is mildly 
stimulating and laxative. 

Occasionally, the shell fish produce an eruption of the 
skin, such as hives or eczema. 

Lobsters , crabs, and shrimps have been termed “scav¬ 
engers of the sea.” In spite of this, the meat is said to 
be wholesome, but none of these are suitable foods for 
invalids, however prepared. 

Phosphorus and Brain Power .—The general belief has 
prevailed that “phosphorus has a special relation to brain 
activity. Because fish was supposed to contain much 
phosphorus it was commonly spoken of as “brain food.” 
It has never been proved that fish is any richer in phos¬ 
phorus than meat, eggs, milk, or certain grains, or that 
phosphorus was more essential to brain activity than 
other elements. 

Frog’s Legs.—In this country, as a rule, only the 
hind legs of frogs are eaten. They are considered rather 
expensive delicacies when the amount of nutriment con¬ 
tained is computed. In some places the meat on other 
parts of the frog is eaten, and the frog as an article of diet 
seems to be growing in favor among the people who can 
afford luxuries. 

Food Value of Broths.—How much real nutriment is 
contained in meat soups and broths is a question that has 
been much discussed. The value of broth is small compared 
to that of the meat fiber, as boiling extracts very little 


EGGS AND FLESH FOODS 


391 


of the protein element. Broth contains the gelatin and 
salts which give flavor to the water. As frequently made, 
broths or soups contain little real nutriment. One author¬ 
ity states that the value of broth lies in the extractives 
that give it flavor, the small amount of gelatin it con¬ 
tains, its power to stimulate the flow of the gastric juices, 
and so whet the appetite rather than satisfy it. . 

The meat left after making the soups still contains a 
large portion of its nutritive elements, and, when combined 
with vegetables or other substances which can be used 
to improve its flavor, it is a useful article of diet. 

The proper cooking and serving of either meat or fish 
have much to do with their food value to the patient. It 
matters little how much the nurse may know as to the 
exact elements contained in the meat, if she does not know 
how, or does not take the pains, to cook it so as to con¬ 
serve its food values and make it agreeable to the taste 
of the invalid. Half-cold meats, gravy, or broth are quite 
sufficient to spoil a whole meal for an invalid. 

Balanced Dietaries. —“The principal classes of food 
materials may be roughly grouped as follows as regards 
the proportion of protein to fuel value, beginning with 
those which have the largest proportion of protein and 
ending with those which contain little or no protein: 


“ Foods containing a 
large amountof pro¬ 
tein as compared 
with the fuel value. 


Fish; veal; lean beef, such as shank, shoul¬ 
der, canned or corned, round, neck, and 
chuck; skimmed milk. 


“ Foods containing a 
medium amount of 
protein. 


Fowl; eggs; mutton, leg and shoulder; beef, 
fatter cuts, such as rib, loin, rump, flank, 
and brisket; whole milk; beans and peas; 
mutton, chuck and loin; cheese; lean 
pork; oatmeal and other breakfast foods; 
flour; bread, etc. 


“ Foods containing lit¬ 
tle or no protein. 


Vegetables and fruit; fat pork; ricejtapioca; 
starch; butter and other fats and oils; 
sugar, sirups. 


“ In planning a well-balanced diet the following points 
must be considered: 


392 


DIETETICS 


“1. The use of any considerable amount of fat meat or 
starchy food should be offset by the use of some material 
rich in protein. Bean soup furnishes a considerable 
amount of protein, while bouillon, consomme, or tomato 
soup are practically useless as sources of nutriment. 
Skimmed milk also furnishes protein, with but very little 
accompanying fats and carbohydrates to increase the fuel 
value. 

“ 2. The use of lean meats or fish for all three meals would 
require the use of such foods as rice, tapioca, or cornstarch 
pudding, considerable quantities of sugar and butter, and 
more vegetables, in order to furnish sufficient fuel value. 

“3. Since flour, sugar, and butter or lard enter very 
largely into pastries and desserts, the larger the quantities 
of these dishes that are consumed, the larger does the fuel 
value tend to become, as compared with the protein.” 1 

CUTS OF MEAT* 

The methods of cutting sides of beef, veal, mutton, and 
pork into parts, and the terms used for the different “cuts,” 
as these parts are commonly called, Vary in different locali¬ 
ties. The diagrams show the positions of the different 
cuts, both in the live animal and in the dressed carcass, as 
found in the markets. The lines of division between the 
different cuts will vary slightly, according to the usage 
of the local market, even where the general method of 
cutting is as here indicated. The names of the same cuts 
likewise vary in different parts of the country. 

Cuts of Beef 

The general method of cutting up a side of beef is illus¬ 
trated in Fig. 112, which shows the relative position of the 
cuts in the animal and in a dressed side. The neck piece 
is frequently cut so as to include more of the chuck than 

'Bulletin, No. 74. t , 

2 This section relating to cuts of meat and the accompanying 
diagrams are taken from Government Bulletin, No. 34. 



1. Neck. 

2. Chuck. 

3. Ribs. 

4. Shoulder clod. 

5. Fore shank. 

6. Brisket. 

7. Cross-ribs. 

8. Plate. 

9. Navel. 

10. Loin. 

11. Flank. 

12. Rump. 

13. Round. 

14. Second cut round. 

15. Hind shank. 


Fig. 112.—Diagrams of cuts of beef. 


393 









394 


DIETETICS 


is represented by the diagrams. The shoulder clod is 
usually cut without bone, while the shoulder (not indi¬ 
cated in diagram) would include more or less of the shoul¬ 
der-blade and of the upper end of the fore-flank. Shoulder 
steak is cut from the chuck. In many localities the plate 
is made to include all the parts of the forequarter, desig¬ 
nated on the diagrams as brisket, cross-ribs, plate, and 
navel, and different portions of the plate, as thus cut, are 
spoken of as the “brisket end of plate” and “navel end 
of plate.” This part of the animal is largely used for corn¬ 
ing. The ribs are frequently divided into first, second, 
and third cuts, the latter lying nearest the chuck and being 
slightly less desirable than the former. The chuck is 
sometimes divided in a similar manner, the third cut of 
the chuck being nearest the neck. The names applied 
to different portions of the loin vary considerably in diff¬ 
erent localities. The part nearest the ribs is frequently 
called “small end of loin” or “short steak. The other 
end of the loin is called “hip sirloin” or “sirloin.” Be¬ 
tween the short and the sirloin is a portion quite generally 
called the “tenderloin,” for the reason that the real tender¬ 
loin, the very tender strip of meat lying inside the loin, 
is found most fully developed in this cut. “ Porterhouse 
steak” is a term most frequently applied to either the short 
steak or the tenderloin. It is not uncommon to find the 
flank cut so as to include more of the loin than is indicated 
in the figures, in which case the upper portion is called 
“flank steak.” The larger part of the flank is, however, 
very frequently corned, as is also the case with the rump. 
In some markets the rump is cut so as to include a portion 
of the loin, which is then sold as “rump steak.” The 
portion of the round on the inside of the leg is regarded 
as more tender than that on the outside, and is frequently 
preferred to the latter. As the leg lies upon the butcher’s 
table this inside of the round is usually on the upper or 
top side, and is, therefore, called “top round.” Occasion¬ 
ally the plate is called the “rattle.” 


EGGS AND FLESH FOODS 


395 


Cuts of Veal 

The method of cutting up a side of veal differs consider¬ 
ably from that employed with beef. This is illustrated 
by Fig. 113, which shows the relative position of the cuts 
in the animal and in a dressed side. The chuck is much 
smaller in proportion, and frequently no distinction is 
made between the chuck and the neck. The chuck is 
often cut so as to include a considerable of the portion 



here designated as shoulder, following more nearly the 
method adopted for subdividing beef. The shoulder of 
veal as here indicated includes, besides the portion corre¬ 
sponding to the shoulder in beef, the larger part of what 
is here classed as chuck in the adult animal. The under 
part of the forequarter, corresponding to the plate in the 
beef, is often designated as breast in the veal. The part 
of the veal corresponding to the rump of beef is here in- 










396 


DIETETICS 


eluded with the loin, but is often cut to form part of the 
leg. In many localities the fore and hind shanks of veal 
are called the “knuckles.” 


Cuts of Lamb and Mutton 

Figure 114 shows the relative position of the cuts in a 
dressed side of mutton or lamb and in a live animal. The 
cuts in a side of a lamb and mutton number six, three in 
each quarter. The chuck includes the ribs as far as the 
end of the shoulder-blades, beyond 
which comes the loin. The flank is 
made to include all the under side of 
the animal. Some butchers, however, 
make a larger number of cuts in the 
forequarter, including a portion of the 
cuts marked “loin” and “chuck” in 
Fig. 114, to make a cut designated as 



1. Neck. 

2. Chuck. 

3. Shoulder. 



Fig. 114.—Diagrams of cuts of lamb and mutton. 


“rib,” and a portion of the “flank” and “shoulder” to 
make a cut designated as “brisket.” The term “chops” 
is ordinarily used to designate portions of either the 
loin, ribs, chuck or shoulder, which are either cut or 









EGGS AND FLESH FOODS 


397 


“chopped” by the butcher into pieces suitable for frying 
or broiling. The chuck and ribs are sometimes called 
the “rack.” 

Cuts of Pork 

The method of cutting up a side of pork differs consider¬ 
ably from that employed with other meats. A large por¬ 
tion of the carcass of a dressed pig consists of almost clear 
fat. This furnishes the cuts which are used for ‘ 1 salt pork 11 



Fig. 115.—Diagrams of cuts of pork 

and bacon. Figure 115 illustrates 
a common method of cutting up 
pork, showing the relative position 
of the cuts in the animal and in 
the dressed side. The cut desig¬ 
nated as “back cut” is almost 
clear fat and is used for salting 
and pickling. The “middle cut” 
is the portion quite generally used 
for bacon and for “lean ends” salt pork. The belly is 
salted or pickled or may be made into sausages. 

Beneath the “back cut” are the ribs and loin, from 
which are obtained “spareribs,” “chops,” and roasting 
pieces, here designated by dotted lines. The hams and 
shoulders are more frequently cured, but are also sold 










398 


DIETETICS 


fresh as “pork steak.” The tenderloin proper is a com¬ 
paratively lean and very small strip of meat lying under 
the bones of the loin and usually weighing a fraction of a 
pound. Some fat is usually trimmed off from the hams 
and shoulders, which is called “ham and shoulder fat, 
and is often used for sausages, etc. What is called, leaf 
lard,” at least in some localities, comes from the inside 
of the back. It is the kidney fat. 


CHAPTER XLIII 

VEGETABLE FOODS 
CEREALS 

Of all vegetable foods, cereals rank first in importance. 

The cereals most frequently used as food are wheat, rice, 
corn, barley, oats, and buckwheat. Of these, wheat is 
the most important. It has been found that, with the 
exception of milk, bread made from wheat will support 
life and strength better than any other single food. 

Bread.—All breads are nutritious foods, but experi¬ 
ments have shown that white bread yields the largest 
percentage of digestible nutritive materials, whole-wheat 
bread stands next, and Graham bread last. The coarser 
flours, containing a certain amount of bran, have a slightly 
laxative effect and are useful where there exists a tendency 
to constipation. 

It is a well-known fact that the food value of bread 
does not depend wholly on the ingredients it contains. 
It must be light to be well digested, so that the nutriment 
can be appropriated. Wheat contains tissue-building 
elements, starch, sugar, and is rich in phosphates. It lacks 
fats and salts needed to make it a complete food. Badly 
made bread is a common cause of dyspepsia. 

Stale bread differs from fresh bread in that the water 
has shifted from the interior of the loaf to the crust. In 



VEGETABLE FOODS 


399 


fresh bread the crust is crisp and dry and the interior is 
moist and easily compressed into lumps. This is probably 
the reason why fresh bread seems to offer more resistance 
to the digestive juices than stale bread. As a rule, fresh 
bread is likely to be less thoroughly divided and made ready 
for digestion than stale bread, which easily separates into 
crumbs. 

Toast increases the digestibility of bread if the toast 
is properly made. The slices should be thin, so that the 
heat may penetrate throughout and render it crispy. If 
the outer layers only are scorched, the inner part of the 
slice is rendered soggy and less easily digested than before 
it was toasted. 

In the cooking of bread the starch in the crust, under 
the influence of the extreme heat, is changed into dextrin, 
and when bread is properly toasted, a similar process 
takes place, which leaves less work for the digestive organs 
to do. All starch must be converted into dextrin or sugar 
before it can be assimilated. 

Macaroni is made from hard Italian wheats, rich in 
gluten, and from which starch has been partly removed. 
Sir Henry Thompson, an English authority on foods, 
says of it: “Weight for weight, macaroni may be regarded 
as not less valuable for flesh-making purposes in the animal 
economy than beef or mutton. Most people can digest 
it more easily and rapidly than meat. It offers, therefore, 
an admirable substitute for meat, particularly for lunch 
or midday meals. Cooked alone with water it is somewhat 
tasteless, but when combined with cheese or stock it makes 
an agreeable food.” It needs very thorough boiling and 
should be given only to persons with good digestive 
powers. 

Breakfast foods have become an exceedingly import¬ 
ant commercial product in the United States and Canada, 
and extravagant claims are made as to the nutritive value 
of different brands. A great many people have placed 
reliance on such statements as these accompanying the 
package: “One package (1 pound) is equal to 4 pounds 


400 


DIETETICS 


of oatmeal in nutriment.” “This food is particularly 
recommended for nursing mothers, to increase the quantity 
and quality of the breast milk.” “This is a condensed 
food, about 4 heaping teaspoonfuls being sufficient for 
the meal.” “One pound of this food is equal to 10 pounds 
of meat, wheat, oats,” etc. 

Most of these foods are manufactured from wheat, corn, 
or oats, and as a fountain cannot rise higher than its source, 
it is impossible for these foods to contain more nutriment 
than the original grain. 

Nearly all breakfast foods contain considerable fiber 
and mineral matter, besides starch and some gluten. The 
fiber helps to excite peristalsis and most of these foods 
are wholesome for the average person. 

In actual nutritive value oatmeal (rolled oats) stands 
at the head of the list. It contains more protein than 
other breakfast foods, besides starch and a certain propor- 
tion of fat. 

All cereal foods need to be very thoroughly cooked. A 
common reason why cereal foods disagree with certain 

individuals is insufficient cooking. 

Vegetarianism, and the use of uncooked foods, are 
advocated by certain groups, as systems on which indi¬ 
viduals who desire to be healthy should base their daily 
dietaries. 

Vegetarians hold that meat and flesh foods in general 
are not only unnecessary to the human family, but have 
an injurious effect. The claims are that vegetarians or 
those who restrict their diet to foods derived from the 
vegetable kingdom, with eggs and milk in addition, have 
greater endurance than meat eaters, and are generally 

healthier. . 

Meat eating is condemned for the following reasons by 

a small group of scientists: 

“It causes an overconsumption of protein, which pro¬ 
motes certain diseases. 

“It greatly promotes the growth of bacteria m the in¬ 
testinal tract. 


VEGETABLE FOODS 


401 


‘It tends to rheumatic troubles through the increased 
accumulation of uric acid in the system. 

There is an increased danger from ptomain poisoning 
from the rapid fermentation of flesh foods.” 

These wholesale condemnations of meat eating have 
never been accepted as facts by the medical profession; 
though it is admitted that the excessive use of meat in 
the diet places upon the human organism unnecessary 
burdens and promotes any tendency that may exist 
toward ailments associated with the by-products of pro¬ 
tein metabolism.” 

“No proof is yet forthcoming that a reasonable diet of 
flesh and vegetables is any more dangerous to health 
through bacterial development than is a purely vegetable 
diet” (Jordan). 


VEGETABLES 

Vegetables may be divided into various classes. Nutri¬ 
tive vegetables and flavor vegetables is a convenient classi¬ 
fication. Nutritive vegetables would include rice, pota¬ 
toes, peas, beans, and lentils. Flavor vegetables would 
include those having mineral salts, but otherwise little or 
no food value. In this class are lettuce, celery, spinach, 
onions, radishes, cabbage, cucumbers, tomatoes, and tur¬ 
nips. There are also a number of vegetables which seem 
to be on the border between these classes. The flavor 
vegetables are useful in giving variety to the diet. Most 
vegetables contain a certain amount of woody fiber, which, 
though it is indigestible, serves a useful purpose in giving 
the bulk to the food needed for complete digestion and 
in stimulating peristalsis. Pungent vegetables, such as 
onions, radishes, etc., slightly stimulate the secretion of 
digestive fluids. 

Rice contains a large amount of starch in an easily 
digested form. In general composition it resembles the 
potato. When combined with milk or other substances, 
which supply the protein and fat which it lacks, it is a 
useful food. 

26 


402 


DIETETICS 


Beans, peas, lentils, and peanuts constitute the class 
of vegetables known as legumes. In food value they ran 
next to the cereals. Lentils are produced in France and 
other European countries, but are little used m America. 
All these foods contain protein and fat and are liable to 
cause intestinal fermentation in those with feeble digestive 
powers. When young they are a wholesome nutritious, 
and easily digested food, but when old, if used at all foi 
invalids, or after having been dried, they are best served 
in the form of purSe. As they contain elements similai 
to meat, they can often be used as substitutes for flesh 

^Potatoes contain a high percentage of starch, which, 
as a rule, is easily digested. If the potato is mealy or 
"floury” it is readily digested, but if after boiling it is 
close and “waxy,” it is not a desirable food for invalids 
who have feeble digestive powers. The sweet-potato con¬ 
tains about 10 per cent, of sugar, is less easily digested 
than the white potato, and less suitable for the sick. 
Potatoes are most easily digested if cooked by baking in 
their skins. Steamed and mashed potatoes would rank 
next in digestibility. It is never advisable to give potatoes 
in chunks to invalids, or to children who have not been 
taught to thoroughly masticate their food. In a great 
many cases, when potatoes in solid pieces are swallowed, 
they pass undigested through the whole alimentary tract. 

Potatoes contain certain mineral salts which are valu¬ 
able as a preventive of scurvy. These salts are lost to a 
considerable extent when the potato is peeled before cook- 


m g 9 

(Scurvy is a disease resulting from malnutrition, said 
to be due to the lack of fresh vegetables and fruits in the 
diet. It has occurred in past years, to a considerable 
extent, among soldiers, sailors, and in prisons, and quite 
frequently among infants, both poor and rich. Hence, 
although many vegetables and fruits seem to have little 
nutritive value, they are essential to health). 

Botanical Classification—Vegetables are occasionally 
classified according to the parts of the plant used. 


VEGETABLE FOODS 


403 


1. Roots and tubers, such as potatoes, beets, carrots. 
Succulent tubers include carrots, parsnips, turnips, salsify, 
and radishes. 

2. Fruit, as squash, cucumber, tomato. 

3. Leaf, as lettuce, cabbage, spinach. 

4. Stem, as celery, asparagus, and rhubarb. 

5. Flower, as cauliflower. 

Sugars are an important form of vegetable food, but 
not necessary for life, if starch and fats are included in the 
diet. Sugars produce heat and force and tend to the 
production of fatty tissue in the body. Sugar possesses 
certain antiseptic or preservative properties, is highly 
concentrated, is quickly dissolved, and, therefore, taxes 
the digestive organs very little. When taken to excess 
it tends to fermentation, the appetite for other food is 
lessened, and also the digestive fluids. 

In flatulent dyspepsia, gastritis, gout, rheumatism, 
obesity, diabetes, and in the uric-acid diathesis, sugar is 
usually forbidden entirely or used very sparingly. 

Glucose or grape-sugar is present in almost all fruits and 
is manufactured from starch. 

Saccharin is a substance derived from coal-tar. It is 
said to be 280 times sweeter than cane-sugar, is also an 
antiseptic, and is used as a substitute for sugar in diabetes 
and other diseases. 

The chief sources of sugar are the sugar-cane and beet 
root. The maple tree yields some. 

Honey is a form of cane-sugar gathered by bees from 
flowering plants. 

The Candy Habit .—The intense activity of the growing 
child requires energy-producing food materials in abun¬ 
dance. There is a physiologic demand for sugar in chil¬ 
dren that is ordinarily met by its moderate use in cakes, 
desserts, etc. Indulgence in candy at any or all hours 
lessens the appetite for other wholesome foods which the 
body needs. Even in homes of wealth undernourishment 
in children has frequently been found owing to the too 
free use of candy and other sweet substances, 


404 


dietetics 


FRUITS 

Fruits contain a considerable proportion of water, 
starch, sugar, and acids. 

The uses of fruits are summed up as follows: 

1. To furnish nutriment. 

2. To convey water to the system and relieve thirst. 

3 * To introduce various salts and organic acids which 
improve the quality of the blood and react favorably upon 
the secretions. 

4. As antiscorbutics. 

5. As diuretics and to lessen the acidity of the urine. 

6. As laxatives and cathartics. 

7. To stimulate the appetite, improve digestion, and 
give variety in the diet. 

Fruits affording the most nutriment are bananas, dates, 
figs, prunes, and grapes. 

The digestibility of fruits depends to a considerable 
extent on ripeness and freshness and the condition of the 
user. Fruits considered to be easily digested are grapes, 
oranges, grape-fruit, lemons, cooked apples, figs, peaches, 
strawberries, and raspberries. 

Fruits less easily digested are melons, prunes, raw apples, 
pears, apricots, bananas, and fresh currants. 

Fruits Most Suitable for Invalids— Thompson gives the 
following: Lemons, oranges, baked apples, stewed prunes, 
grapes, banana meal (not the fruit pulp). 

Bananas form the staple article of food in the countries 
in which they flourish, but are not easily digested. Banana 
meal is used to some extent in the form of gruel in cases 
of irritability of the stomach and nausea. It is said to 
possess certain advantages over the other starchy sub¬ 
stances commonly used for that purpose. 

Fruits with seeds or skins should not be given to young 
children nor to persons with feeble digestive powers. 

Nuts possess decided nutritive properties, but have the 
reputation of being hard to digest. This difficulty fre¬ 
quently arises from insufficient mastication, and from the 
1 W. Gilman Thompson. 


VEGETABLE FOODS 


405 ' 


fact that they are usually eaten after a full meal. They 
are recommended to be taken as a substitute for meat or 
part of the meat at a meal. Peanuts are not really nuts, 
but legumes, which grow under ground. All nuts contain 
considerable fat. The cocoanut, chestnut, almond, and 
English walnut contain most nutriment. All nuts are 
best omitted from the invalid’s dietary because of diffi¬ 
culty in digestion. 

CONDIMENTS 

The chief uses of condiments are as follows: 

To give flavor and relish to food. 

To stimulate appetite. 

To promote digestion. 

Many condiments have antiseptic and carminative 
properties. The principal condiments are: Salt, mustard, 
nutmeg, vinegar, horseradish, cinnamon, pepper, ginger, 
cloves, and vanilla. 

Salt.—Of these, common salt is the most important. 
One authority states that the reason why salt is so exten¬ 
sively used is that in our methods of preparing foods they 
lose most of their original saline ingredients. 

Vinegar is an antiseptic and acts as a preservative of 
food. It is believed by some medical writers that ex¬ 
cessive use of vinegar lessens the red blood-corpuscles. 
It is said also to interfere with salivary digestion. In fact, 
the free or excessive use of any of the condiments is likely 
to cause irritation and disorder of the digestive organs. 

Besides the condiments mentioned, there are various 
others, such as mint, thyme, parsley, sage, etc., which 
are used to improve the flavor of foods. 

BEVERAGES 

The three common and popular aromatic beverages— 
tea, coffee, and cocoa—though different in general char¬ 
acteristics, contain alkaloids which are almost identical. 

Tea.—A great many varieties are imported into the 
United States, mostly from China, India, and Ceylon. 
The so-called green and black teas grow on the same plant, 


406 


DIETETICS 


the difference being in the time of gathering the leaves 
and the method used in preparing them. 

Tannin is an astringent found in both tea and coffee. 
In strong solutions it gives rise to constipation and other 
digestive disorders and renders inert the gastric fluids. 
Green tea contains more than twice as much tannin as 
black tea. It is said that tannin is particularly likely to 
interfere with the digestion of fresh meats. 

The stimulating properties of tea are due to the alkaloid 
them, which is almost identical with caffein in its action. 

Good Effects .—The good and bad effects of tea are ques¬ 
tions on which decided differences of opinion exist, but 
most authorities agree that tea lessens fatigue, promotes 
clearness of mind and intellectual energy, and acts as a 
stimulant to the nervous system. 

Green tea possesses more active properties than black. 
When milk and sugar are added to tea a certain amount 
of nutriment is supplied. Tea alone is not a food, but 
the use of tea leads to the introduction of hot water into 
the system, which assists the general functions. 

Bad Effects .—If taken in large quantities or in strong 
solution tea causes sleeplessness, precipitates the digestive 
ferments, retards digestion, and may lead to muscular 
tremors and palpitation. 

One noted medical writer 1 states that the best way to 
minimize the bad effects of tea on digestion is to make 
it very weak, use it sparingly, and drink it after, but not 
with, a meal. He claims that the addition of 10 grains 
of soda bicarbonate to each ounce of dry tea entirely 
removes this retarding effect on digestion. 

Tea should never boil; the water used in making tea 
should be freshly boiled, and should be poured on the 
tea not more than two or three minutes before it is to be 
used. 

Coffee is imported from Brazil, Java, Ceylon, and other 
countries. It consists of the berries or seeds of the coffee 
tree. The seeds are commonly known as coffee beans. 

1 Sir William Roberts. 


VEGETABLE FOODS 


407 


It is frequently adulterated with chicory. The choicest 
coffee is said to be the Mocha or Arabian. An impor¬ 
tant part of the preparation of coffee is the roasting, 
which develops its aromatic properties. The best coffee 
is made from berries which have been freshly roasted and 
ground. 

Coffee contains the volatile oil which gives it its peculiar 
aroma, less tannin than tea, and caffein. It can be made 
either as an infusion or a decoction. The latter method 
is most frequently used. If boiled long or left standing, 
it extracts more and more of the tannin and is more 
likely to interfere with digestion. 

Good Effects .—Like tea, coffee is a stimulant to the 
nervous system, diminishes the sense of fatigue, stimulates 
the heart, increases the action of the kidneys, and is said 
to be slightly laxative. 

Ill Effects .—It may produce heart-burn, cause torpidity 
of the liver, disturb digestion, and when used to excess 
produce various nervous symptoms. On children either 
tea or coffee act disastrously, giving rise to night terrors, 
nervousness, and tremor. 

Posturn is a coffee substitute made from cereals, which 
is relished by many, and leaves no ill effects. 

Cocoa and chocolate are obtained from the cocoa 
bean, the seeds of a tree which grows in the British West 
Indies, Brazil, and other parts of South America. The 
kernels of the roasted seeds are known as “cocoa nibs.” 

Cocoa contains a considerable amount of fat, known 
as cacao butter, some starch, some albuminous substances, 
the volatile oil which gives it its peculiar aroma, and an 
alkaloid known as theobromin, which closely resembles 
thein and caffein. 

Chocolate is manufactured from cocoa, with sugar and 
other flavoring substances added. 

Cocoa forms a highly nutritious drink when prepared 
either with or without milk. The amount of oil it con¬ 
tains renders it a rich drink and liable to disagree with 
invalids who have feeble digestive powers. 


408 


DIETETICS 


CHAPTER XLIV 

DIET FOR THE SICK 

Intelligent feeding of any invalid is only possible when 
the practise is based on a knowledge of foods in general 
and their adaptibility to diseased conditions. A nurse 
who only knows how to blindly carry out orders may tide 
a patient over a crisis successfully, providing the orders 
are so explicit and definite that “a wayfaring man though 
a fool need not err therein.” But so many conditions 
enter into successful feeding, especially in acute diseases 
characterized by fevers, that it is rarely possible for even 
the most accurate and painstaking physician to anticipate 
all the needs of any one case, and leave orders accordingly. 
The nurse’s judgment has to be relied on to a large extent 
in meeting the difficulties presented in many cases. 

There are certain general symptoms present in all fevers, 
and local conditions may modify or exaggerate the symp¬ 
toms of any fever. In all acute febrile conditions we may 
expect dry, hot skin, thirst, full pulse with increased rate, 
coated tongue, more or less digestive disorder, loss of 
appetite often amounting to a loathing of food, headache 
occasionally, pain in a greater or less degree in the back 
and limbs at some stage, and elevation of temperature. 
In all fevers there is increased tissue waste, due to a per¬ 
version of the physiologic processes. 

In most severe febrile diseases the glands of the stomach 
and intestines that secrete digestive fluids are inactive 
and incapable of digesting enough food to keep pace with 
the rapid waste of tissue. There is nearly always an ex¬ 
cess of urea in the urine, the amount often exceeding that 
excreted by an active healthy individual on a full diet. 
In severe cases “the stomach loses its normal office and 
becomes merely a conduit to pass the liquid food to the 
duodenum. Not perhaps that there is, except in extreme 
cases, an absolute abeyance of gastric secretion and gastric 


DIET FOR THE SICK 


409 


action, but that they are reduced to so low an ebb that they 
count for practically nothing in the work of digestion. ,, 1 

It should also be remembered that there exists in many 
cases a tendency to accumulation in the body of waste 
tissue products resulting from the rapid destruction of 
tissue. These waste products act as poison in the system, 
and as far as possible foods should be used that will not 
clog the system and that will favor elimination. 

General Principles.—1. In acute febrile diseases all 
authorities agree that food should be in fluid form, so that 
it can be easily and quickly absorbed. 

2. It should be given in small amounts and at com¬ 
paratively short intervals. 

3. It should be of such form and quality as to convey 
the maximum amount of nourishment with the minimum 
tax on the digestive powers. 

4. Foods should be avoided that are likely to disagree 
with the present'condition of the patient. 

5. Food should be used to the greatest extent that is 
safe and possible, in order to lessen tissue loss. 

6. Abundance of water should be given to replace the 
depleted fluids of the body, to lessen thirst, and carry off 
waste. 

Most medical writers agree that less tissue waste results 
when the patient is supplied with plenty of the nitrog¬ 
enous elements of food. The theory is that the proteid 
substance contained in the food is burned instead of the 
proteid elements stored in the body structures. The 
nitrogenous food given does not go to produce tissues, 
but to spare them from the excessive waste due to the 
fever. 

In all fevers where there is regular remission it is better 
to increase the supply of nourishment during the hours 
when the fever is lowest. It is believed that better diges¬ 
tion and absorption are possible at such times, the tissues 
appearing to regain to some degree their power of assimila¬ 
tion. 


1 Sir William Roberts. 


410 


DIETETICS 


The foods chiefly relied on in the acute stage of fevers 
are milk, animal broths, eggs, and gelatin. Of these, in 
importance, milk stands first. There is, however, always 
the danger of milk coagulating in indigestible masses in 
che stomach unless properly administered, and the success¬ 
ful management of a fever case on an exclusive milk-diet 
requires intelligence and skill. Much of the distention of 
the abdomen and physical discomfort of typhoid fever 
patients is attributed by some physicians to injudicious 
methods of administering milk. As there is practically 
no other food that compares with milk in nutritive value 
and general desirability as a food for invalids, every nurse 
should study to administer it so that it will not disagree 
and will be easily digested and assimilated. 

In a great many cases thin carefully cooked and strained 
gruels may be added to the milk that will increase its di¬ 
gestibility. 

Gelatin prepared with various flavors is strongly recom¬ 
mended by some medical writers for use in fevers because 
of its value in preventing tissue waste. The gelatin may 
be added to many broths with advantage, because while 
broths contain mineral elements that the body needs, and 
water is also needed, they are not rich in actual nutritive 
substances. 

The amount of nourishment contained in broths is a 
very variable quantity, and a good many specimens are 
little more than flavored water. One difficulty with 
broths is that if there is any tendency to diarrhea the use 
of almost any animal broth is likely to increase it. A 
small amount of cornstarch or arrow-root added to broth 
increases the nutriment and is usually well borne. 

A milk-free diet, containing strained rice-water, oat¬ 
meal gruel, meat-juices, egg, gelatin, and zweiback, has 
been used with good results, and is strongly recommended 
by some physicians for use in typhoid fever. 


DIET FOR THE SICK 


411 




For the patient on light diet. 













412 


dietetics 


FOOD PREPARATION AND SERVING 

In previous lessons the fact has been emphasized that 
the manner in which food is cooked and served has much 
to do with the appetite for it, and appetite has much to do 
with digestion. 

It should be borne in mind that because the range ot 
foods admissible in the invalid’s dietary is limited, special 
care must be used in the preparation of the materials 
allowed, so that no carelessness or failure on the part of 
the nurse shall spoil the meal or cause a distaste for foods, 
or which would tend to monotony, when every effort 
should be made to secure variety. To give variety while 
adhering to simple, easily digested foods, to excite appetite, 
and at the same time avoid the use of “ indigestibles 
which the invalid often craves, calls for skill and good 
judgment. 

In no other part of nursing do little things count for 
more and the importance of the little things is rarely 
sufficiently appreciated until years of experience have 
been gained. It has been a source of astonishment in 
dealing with pupil nurses to find how few there are who 
on entrance to a hospital know how to prepare and serve 
a cup of tea, a piece of toast, or an egg so that the result 
could be pronounced “exactly right.” 

Essentials to Success.—These would include a great 
many details, but the very first is cleanliness. 

1. Cleanliness of food, of utensils used in cooking, of all 
dishes used in serving, of tray linen, of the patient’s hands, 
and general surroundings. 

2. Neatness .—Next would come neatness. A meal and 
surroundings may be clean, but the tray be far from neatly 
or carefully set. 

3. Quality of Food .—Food supplies should be the best 
quality obtainable; they should be fresh, there should be 
as much variety as is permissible. 

4. Preparation of Food .—The methods used should be 
simple and the foods should be freshly cooked. Fried 
foods are not usually desirable for invalids. The sea- 


DIET FOR THE SICK 


413 


soning and flavoring should accord, as far as possible, with 
the patient s tastes. Usually in sickness the sense of 
taste is very acute, and less seasoning is needed. Strong 
flavors should be avoided. Fat should be carefully 
removed before serving broths. Gravies containing much 
grease are undesirable for invalids whose digestion is at 
all impaired. Foods twice cooked or warmed over should, 
as a rule, be avoided. 

5. Temperature of food is exceedingly important. Hot 
foods should be served hot, but not so hot that the patient 
has to wait for them to cool before he can eat. Hot food 
should be covered in transit. Cold foods should be cold, 
never lukewarm. 

6. Amount of Food .—Care should be used to avoid serv- 
ing too much at one time and still be sure that enough 
has been given to satisfy, unless the amount is restricted. 

7. Punctuality .—This applies to both cooking and serv¬ 
ing. Punctuality and regularity in serving meals to an 
invalid is quite as necessary as in giving medicines. In 
the cooking of foods the time needs to be carefully con¬ 
sidered. Custards intended to be served cold should be 
cooked long enough in advance for the cooling to take 
place. Many foods are spoiled by standing after being 
cooked. A baked potato is delicious and easily digested 
when cooked just right and promptly served, but what is 
more unappetizing than a baked potato that has remained 
after cooking in a slow oven till it is soggy and half cold. 
Tea is appetizing if made with freshly boiled water and 
served within three minutes after infusion. It is spoiled 
if prepared too long in advance. These illustrations might 
be multiplied indefinitely. Ices should not be served at 
the same time the hot food is served. 

8. Artistic touches count for much more in the serving 
of meals to invalids than to persons in health. A patient 
who had no desire for food will often be beguiled into tak¬ 
ing it, and will relish it, if care is taken to present it in the 
most attractive form. Daintiness about serving nourish¬ 
ment is a great help in attracting the eye and arousing 


414 


DIETETICS 


interest. The prettiest dishes the place affords should be 
pressed into service, and when possible a change of pattern 
of dishes occasionally is worth while. If a single article 
or two of food only are to be served, a small tray rather 
than a large one should be used. Care should be used to 
avoid crowding a tray with too many dishes. It is better 
to use a second tray for serving dessert or fruit than to pile 
too much on one tray and have it lack in order and neat- 
ness. When the sick room is not too far from the kitchen, 
serving a meal in courses is a good plan. As far as possible 
the element of unexpectedness should enter into a meal. 

Elaborate garnishing of dishes should be avoided, but 
a touch of green is always permissible, and lettuce, parsley, 
and watercress can be made to serve quite as useful a pur¬ 
pose in the sick room as elsewhere. 

A spray of maiden-hair fern or any of the dainty green 
effects can sometimes be used for decoration. The use of 
flowers on a tray is laudable, but these should be restricted 
to a single blossom with a touch of green or a full-blown 
flower of some of the dainty varieties. However one 
may admire an American beauty rose or a peony, or a 
large bouquet of any kind of flowers, they are out of place 
on a tray. A real good joke or an apt quotation, clipped 
from some of the current journals and laid on a tray, wifi 
often add zest to a meal and divert the patient s thoughts 

from himself. . 

Cracked or unmatched dishes do find their way to in¬ 
valid’s rooms in hospitals. Green cups and blue saucers 
are hastily set together by careless nurses, but such 
blunders destroy any artistic effect the tray might other¬ 
wise have. 

A great many dainty ways of serving bread have been 
discovered, and the same is true of potatoes and a great 
many of the simple foods. 

9. Position of the Patient— This is a highly important 
detail in the success of a meal. He should be made as 
comfortable as possible, and put in the most convenient 
position for taking the food. If he lies qn hie side, a small 


DIET FOR THE SICK 


415 


pillow at the back helps to support him. If he is propped 
up, the pillows should be tucked in snugly at the base of 
the spine, and arranged so that the head will not be thrown 
forward on the chest nor be left without support. Grasp¬ 
ing of any part of the body with the finger-tips is an un¬ 
certain and uncomfortable method of giving support. If 
the hand is placed behind the back, the full breadth of the 
hands should be used, and a small pillow between the 
hands and the patient will increase the comfort. In short, 
the task of eating and drinking should be made as easy,' 
comfortable, and pleasant to the patient as it is possible 
to make it. 

10. General Details. A thoughtful nurse will be on the 
alert to promote the convenience and comfort of the 
patient in every way during the meal. She will not allow 
a glass or cup to stand in a pool of fluid in the saucer and 
drip every time it is carried to the patient's mouth. She 
will, if necessary, cut the meat into small pieces. She will 
assist in pouring the tea, if desirable, in removing dishes 
used to keep the food hot, in preparing eggs boiled in 
shells to be eaten; in removing soiled dishes if the tray is 
crowded. She will at once remove the tray after the 
meal has been taken. She will not be guilty of leaving 
milk or food standing around in the sick room in the hope 
the patient may suddenly desire it. Freshness, as far as 
it is possible to obtain it, is a good rule in all matters relat¬ 
ing to food. 

Feeding of Helpless Patients.—If the patient's head 
has to be raised to take the fluid food, it should be done by 
slipping the hand underneath the pillow, and raising it 
rather than lifting the head only. Care should be used 
never to have the glasses or cups too full. 

As a rule, when a patient craves water or fluids and the 
amount is restricted, it is better to give it in a small glass 
which is nearly filled and allow him to empty it, than to 
give it in a large glass partly filled, which he is not 
allowed to drain. 

Glass tubes used for feeding should be bent. Feeding- 


dietetics 


416 



tty,.. . _ . , 

diately in front of it in line with the plate. 



A luncheon tray. (Photograph by courtesy of Woman’s Home Companion.) 












DIET FOR THE SICK 


417 



A luncheon rich in protein—cheese toast, beef balls, and ice cream. (Photo ¬ 
graph by courtesy of Woman’s Home Companion.) 



A light dinner tray. Creamed codfish with potato border, lightly browned; 
toasted triangles, and orange basket. (Photograph by courtesy of Woman’s 
Home Companion.) 


27 









418 


DIETETICS 


cups should be held so as not to allow the fluid to flow 
too quickly. 

Unconscious patients should have only fluid food, and 
it should be administered very slowly, from a spoon or 
medicine-dropper. Only a teaspoonful at a time should 
be given, and the nurse should be sure it is swallowed 
before giving more. If less than ^ dram is given it is not 
likely to be swallowed, as swallowing is not induced by 
a few drops of fluid. 

When rectal feeding is necessary, the general rules given 
regarding administration of medicine by rectum should be 
observed. 

HOSPITAL DIETARIES 

The need for extreme accuracy in the arrangement of 
hospital dietaries has led to the adoption of certain stand¬ 
ard diets suitable for the varying conditions of the pa¬ 
tients. The following diet schedules afford a chance for 
variety for nearly all types of patients. 

Liquid Diet 

Feeding every two hours , 6 oz. each 

Meat broths; meat juices; strained soups; fruit juices 
with water; albuminized drinks; cereal gruels; tea, coffee; 
cocoa (if permitted); milk (if permitted); Bulgarian milk. 

Soft Diet 

Feedings every three hours 

Any liquid food; cream soups; milk—whole and Bul¬ 
garian; custards; junkets; ice-cream and ices; gelatin; 
cereals; eggs—soft cooked; milk toast—butter; blanc 
mange; stewed fruits—well cooked and strained; cottage 
cheese; tapioca; rice. 


Light Diet —A 

Any liquid food or foods on Soft Diet; puree of vege¬ 
tables; potatoes, baked or mashed; rice; desserts—tapioca, 
rice, cornstarch puddings, prune whip; bread—white and 


DIET FOR THE SICK 


419 


whole wheat; fruits—fresh and stewed; baked apples; 
jellies and preserves. 


Light Diet—B 

Light Diet A with the addition of meats: Chicken; 
sweet breads; lamb chops; tender steak; fish and oysters; 
all cooked vegetables. 

General Hospital Diet 
Breakfast 

Orange, grapefruit, berries, or other fresh fruits; stewed 
fruits; shredded wheat biscuits, Dr. Price’s All-grain 
Food, Ralston’s Breakfast Food, rolled oats, bran or 
cracked wheat, with cream and little sugar; eggs, soft 
cooked, seven minutes or poached; corn muffins, graham 
muffins with butter and honey, syrup; white bread, toast, 
Vienna rolls; one cup coffee or cup of cocoa or glass of hot 
water and cream. 

Dinner 

Creamed vegetable soup; meat broths; meat soups 
without fat. 

Roast beef, roast lamb, roast chicken, roast turkey 
without dressing; stewed chicken, stewed lamb; boiled and 
baked ham; broiled steak, broiled lamb chops; fresh fish, 
baked. 

Cranberry jelly; fruit jellies. 

Stewed or baked white onions, cauliflower, peas, corn, 
lima beans, okra, stewed or baked tomatoes, baked or 
broiled eggplant, artichokes, beets, oyster plant, carrots, 
spinach, asparagus, string beans, well mashed turnips, 
stewed celery; potatoes well mashed, baked or creamed; 
rice well cooked. 

Raw tender celery, ripe olives. 

White, graham, whole wheat rye, or corn bread or toast; 
Vienna rolls, corn muffins with butter, honey, and syrup. 

Lettuce, tomato, and fruit salads with French or May¬ 
onnaise dressing. 

Crackers; cheese. 


420 


DIETETICS 


Stewed fruits; raw fruits; custards; gelatins; corn¬ 
starches; tapioca; junket; prune whip; blanc mange; soft 
vanilla ice-cream; light cakes, such as sunshine or sponge 
cake; English walnuts, pecans, raisins, dates, figs. 

Bulgarian milk, hot water and cream, or cool water. 

Supper 

Mixed vegetable soups; creamed vegetable soups. 

Spaghetti; Schmier Kase; Boston baked beans. 

Eggs: poached, soft cooked, omelet. 

Vegetables same as at lunch. 

White, graham, whole wheat, rye or corn bread or 
toast, Vienna rolls, corn muffins with butter, honey, or 
syrup. 

Stewed fruits; raw fruits. 

Custards; gelatins; cornstarches; tapioca; blanc mange; 
prune whip; junket. 

Bulgarian milk; glass of hot water and cream or cool 
water. 

Low Protein Diet—General 

Cereals: Oatmeal, shredded wheat biscuit, Ralston’s 
Breakfast Food. Dr. Price’s All-grain Food, Pettijohn. 
With cream and sugar. 

Bread: Whole wheat, graham, rye, corn bread (coarse 
meal); graham rolls, bran biscuits, graham crackers, 
Educators, Triscuit. With cream and sugar. 

Green vegetables: Spinach, asparagus, eggplant, oyster 
plant, carrots, beets, beet greens, cauliflower, cabbage, 
Brussels sprouts, squash, baked pumpkin, gumbo, green 
peas, lettuce, tomatoes, rhubarb, kohlrabi. 

Starchy vegetables: Potatoes, rice, spaghetti, hominy 
grits. 

Stewed fruits: Peaches, pears, apricots, plums, prunes, 
cherries, cranberries, berries of all sorts, figs, apples, apple 
sauce, baked apples. Canned fruits are satisfactory if 
recooked. No preserves. Fruit jellies. Oranges and 
grapefruit, but no other uncooked fruits. 

















NOTES 























































































































































































































































































































































NOTES 


NOTES 






SECTION VII 

INVALID COOKERY 


CHAPTER XLV 
SUGGESTIONS TO TEACHERS 

The lessons on invalid cookery which follow have been 
arranged to proceed along with and to complete the teach¬ 
ing of dietetics. They have been inserted in this text-book 
because observation has taught that in many hospitals 
cookery lessons are neglected, while much time is consumed 
in teaching less important subjects. 

A second reason for including these lessons is because a 
course in dietetics is decidedly insufficient and incomplete 
if no practical instructions are given. 

The third reason is, because progressive physicians are 
placing more and more value on proper diet as a weapon 
in overcoming disease, and no twentieth century nurse 
can be considered fully trained if she has not been taught 
how to prepare foods of all kinds for the sick. “If I can 
control the kitchen connected with the sick room, I can 
get along with a large proportion of my patients with 
little or no assistance from the drug store,” was a remark 
made to the author by a prominent physician, and which 
serves to show the necessity of nurses being capable in 
the kitchen if they are to meet the demands of the best 
modern physicians. 

Another reason is because the author has received 
numerous letters from the nurse superintendents of small 

421 



422 


INVALID COOKERY 


hospitals, asking for advice and help as to howtoarrange 
for classes in cookery. Many hospitals are in sin P 
where a specially trained teacher of dietetics is no-avail¬ 
able and if cookery classes are to be held at all, the nu 
superintendent must conduct them. It has hefQWith t^ 
class of teachers especially in view, rather tha 
dietitians, that these directions have been prepared, in 
the hope of making it easier to introduce a cmiree in p^- 
tical cookery into such schools. If_ a visiting dietitian 
can be secured for the practical work, it should be done- 
Much of the theoretical part of the work may be cov¬ 
ered in general class work before lessons in invalid cook- 

er The 6 primary meaning of “nurse” was to nourish, and, 
though the conception of nursing broadens with the years, 
the subject of nourishment-of proper food for the s ck 
and how to prepare it—is to-day receiving more attention 

th It isunfortunately true that a great many young women 
enter hospital schools who have no more definite idea of 
how to prepare food for invalids than they have of general 
numing or medicine or surgery. No subject in the nursing 
course precedes practical nursing in importance, and proper 
feeding is certainly an important part of practical nursing. 

It is expected that the teacher of cooking will give a 
short explanatory talk bearing on each lesson before be¬ 
ginning practical demonstrations. It is not .supposed 
that all the recipes included in every lesson outlined can 
be demonstrated in one class period, but a choice can be 
made of those considered most important. The season 
at which the lessons are given must also be taken into 
account for though most foods can be gotten out of season, 
ft hardly seems wise to purchase fresh fruits or vegetables 
out of season at exorbitant prices for teaching purpose. 

If possible, it seems best to have the class held at an hour 
just previous to a meal, so that the products of the lesson 
may be utilized to give variety to the meal. There is 
always a special incentive to excel if the ar ic 


Suggestions to teachers 


423 


intended for some individual, which incentive is lacking 
when the work is done simply for practice. Besides, there 
is a pecuniary reason why food materials should be utilized. 

As the management of the fire has a great deal to do 
with success in cooking, some explanations regarding this 
point should be given the class in a preliminary talk. 
Because gas is so readily controlled in cooking, it is an 
especially convenient fire to use in teaching beginners, 
but the important points in the management of a coal 
stove should also be mentioned. 

Proper cooking utensils to use in preparing and cooking 
foods should also receive comment. Utensils that make 
no unnecessary labor should have the preference. Indi¬ 
vidual frying pans, egg-beaters, and mixing bowls and 
spoons should be provided for the class. These are all 
inexpensive articles, which can be utilized in various ways 
apart from class work. 

The methods of cleaning the utensils after use, the best 
cleaning agents to use, and the place in which each utensil 
is to be kept, should not be omitted in teaching. 

There are a few general principles which have much to 
do with final success: 

1. Cleanliness of food materials, utensils, cook, and 
surroundings. 

2. Order .—All articles needed for preparing a food 
should be collected before the mixing of the ingredients 
begins. 

3. Economy .—The principle of sensible economy in the 
use of all materials should be insisted on. It is, however, 
a false economy that will run the risk of spoiling an article 
of food by the use of inferior ingredients, or by leaving 
out some ingredient necessary to success. It is, neverthe¬ 
less, a triumph of culinary skill to be able to make appe¬ 
tizing dishes out of inexpensive materials or “left-overs.” 
A well-trained cook is never wasteful. In fact, waste in 
any line, whether it be of human energy or material, is a 
sign of lack of intelligence. 

4. Attention to Details .—An experienced cook may be 


424 


INVALID COOKERY 


able to apparently neglect the business on hand for the 
moment or attend to a dozen things at once, but when an 
amateur cook tries to do the same thing the result is reason¬ 
ably certain to be a failure. Therefore, “ pay careful at¬ 
tention to the work on hand” is a rule worthy of special 
emphasis with amateur cooks. 

5. Accuracy .—An experienced cook may be able to 
guess at quantities of ingredients, but the only safe rule 
for a beginner in cooking is to measure quantities as accu¬ 
rately as possible, calculate time carefully, and follow 
rules. A point at which many inexperienced cooks make 
mistakes is in calculating the time needed for jellies to 
set, custards to cool, etc., and much disappointment re¬ 
sults. The season of year has a little to do with this point, 
which should be discussed in class. 

A celebrated artist was once asked the question,“ What 
do you mix your paints with? ” “ Brains/ ’ was the reply, 

and it applies with equal force to cookery for invalids. 
Real success depends on a great many apparently trivial 
details. The materials used are subject to many varia¬ 
tions. The size of an egg, and even the temperature, 
need to be considered to a certain extent. One egg may 
contain one-half as much more material as another. An 
egg taken out of the refrigerator will require longer to boil 
than one kept in the ordinary living-room temperature. 
Starch is not always equally dry; flour varies; some vege¬ 
tables yield much more liquid than others; cups and spoons 
are of various sizes; lemons differ in the amount of juice, 
and more sugar may be needed than a rule calls for; the 
quality of meat is subject to great variations; the heat of 
the oven is not always the same. These are only examples 
of a great many causes that modify results. No cookery 
book, however carefully arranged, can always supply 
infallible recipes. These modifying conditions must be 
taken into account. Plain, common, every-day sense 
and intelligence must be brought to bear on the ingredients 
and general conditions. 


BEVERAGES AND FLUID FOODS 


425 


CHAPTER XLVI 

BEVERAGES AND FLUID FOODS 
Lesson I 

Water is classed as a food because it is essential in 
forming the tissues and fluids of the body. 

Water suspected to be contaminated should not be used 
foods nn ^ ln ^ With0Ut boilin & nor for washing uncooked 

Tea should always be made with freshly boiled water 
but never boiled. 

Neither tea nor coffee should be depended on as nourish¬ 
ment, except as water adds to the tissues of the body. 

Tea should always be freshly made and used immedi- 
ately. Long infusion renders it injurious. 

Cocoa and chocolate have a nutritive value and, when 
milk is added, are useful as foods. 

Coffee should be made with freshly boiled water. Like 
tea, it becomes injurious from long standing by the ex¬ 
traction of tannin. 

One pint of milk is said to be equivalent in food value 
to 6 ounces of beef or mutton. 

Milk becomes solid by the action of the gastric fluids 
when it enters the stomach. 

When swallowed quickly the casein has a tendency to 
form in lumps. 

Milk diluted with water, hot or cold, is easier to digest 
than pure milk. 

Skimmed milk contains nearly all the protein of the milk. 

LEMONADE OR ORANGEADE 

Ingredients: 1 lemon or orange, $ pint of water, 2 table¬ 
spoonfuls of sugar, 1 tablespoonful of crushed ice. 

Method .—Roll lemon or orange until soft; remove juice, 
being careful to exclude seeds; add sugar; mix; add water; 
mix well; pour over ice and serve at once. May be made 
with hot water if desired. 


426 


INVALID COOKERY 


EFFERVESCING LEMONADE 

Ingredients: Same as above, with J teaspoonful of soda 
added just before serving. 

Method. —Stir well; serve while effervescing. 

FLAXSEED LEMONADE 

Ingredients: 2 tablespoonfuls of whole flaxseed, 1 table¬ 
spoonful of sugar, 2 tablespoonfuls of crushed ice, 1 quart 
of hot water, juice of 1 lemon. 

Method. —Look over and wash flaxseed; pour boiling 
■water over the seed and steep (do not boil) for two hours, 
strain; add lemon juice and sugar; cool, and pour over ice. 
May be served hot if desired. 

ALBUMEN-WATER 

Ingredients: White of 1 egg, i lemon or orange, 2 table¬ 
spoonfuls of crushed ice, a little sugar, water enough to fill 

g Method. —Beat egg slightly; add lemon juice and sugar; 
strain through fine strainer over ice; mix well; fill glass 
with water and serve. 

BARLEY-WATER 

Ingredients: 2 tablespoonfuls of pearl barley, 1 quart 
of cold water, 1 tablespoonful of lemon juice, 1 teaspoonful 
of sugar, \ teaspoonful of salt. 

Method. —Look over and wash barley; soak for two 
hours; pour off water and add fresh; then cook in double 
boiler until soft; strain through coarse strainer; add salt, 
sugar, and lemon juice. The lemon juice may be omitted 
and cream used instead, if preferred. Serve hot. 

OATMEAL-WATER 

Ingredients: \ cupful of oatmeal, 1 quart of cold water, 
\ teaspoonful of salt. 


BEVERAGES AND FLUID FOODS 


427 


Method. —Soak oatmeal in water for one hour; cook 
in double boiler for one hour or until soft; add salt; strain 
through coarse strainer; serve hot or cold. 

TOAST-WATER 

Ingredients: 1 thick slice of bread, J teaspoonful of 
salt, 1 cupful of hot water. 

Method. —Cut bread in cubes; toast brown in oven; 
pour water over toast; add salt; let stand covered until 
cool; strain; serve either hot or cold. 

TEA 

Ingredients: \ teaspoonful of tea (if Ceylon), 1 tea¬ 
spoonful (if any other kind), 1 cupful of boiling water. 

Method. —Scald teapot; place tea in pot; add boiling 
water; let stand in warm place for two minutes; serve at 
once. (Caution: Be sure the water boils before pouring 
on the tea.) 

SLIPPERY-ELM TEA 

Ingredients: 2 teaspoonfuls of slippery-elm powder 
or a piece of slippery-elm bark (about 2 ounces), 1 cupful 
of hot water, 1 tablespoonful of sugar, 1 teaspoonful of 
lemon juice. 

Method. —Pour hot water over powder; let stand cov¬ 
ered until cool; strain; add sugar and lemon juice; serve 
either hot or cold. If bark is used, steep one-half hour 
before straining. 

BEEF-TEA 

Ingredients: 1 pound of lean beef, 1 pint of cold water, 
J teaspoonful of salt. 

Method. —Wipe meat with damp cloth; cut in J-inch 
cubes; put in quart jar; add salt and water; cover, keep 
in cool place for four hours until juices are well started, 
then place jar in pan of cold water on back of stove and 
bring slowly to a boil; strain and serve. It may be served 
hot or frozen if desired. 


428 


INVALID COOKERY 


BEEF JUICE 

Ingredients: % pound of lean beef (round steak is best), 

\ teaspoonful of salt. 

Method. —Wipe meat with damp cloth, place in wire 
broiler; heat over hot fire, but do not brown; cut in small 
pieces; press through meat press (always heat the press 
and bowl); add salt; serve in colored glass. 

If meat is heated in frying pan, a bay leaf or celery stalk 
may be heated with it, giving it a different flavor. Beef- 
juice may be made like beef-tea by omitting water. 

COFFEE AND EGG 

Ingredients: Yelk of 1 egg, \ cupful of hot coffee, ^ 
cupful of hot milk. 

Method. —To the well-beaten yelk add coffee and milk. 

COCOA 

Ingredients: 2 teaspoonfuls of cocoa, 1 teaspoonful of 
sugar, 2 teaspoonfuls of hot water, 1 cupful of hot milk. 

Method. —Mix cocoa and sugar; add hot water; stir until 
dissolved; add milk and bring to a boil; beat with a Dover 
egg-beater until it foams or place a spoonful of whipped 
cream on top of cup before serving it; serve hot. 

POSTUM CEREAL 

Ingredients: 1 tablespoonful of postum cereal, 2 cup¬ 
fuls of water, \ teaspoonful of butter. 

Method. —Place postum in the pot; add water and butter 
and boil for twenty minutes; let stand for one minute to 
settle; strain and serve at once, with cream and sugar. 

WHEY 

Ingredients: 1 pint of milk, 2 teaspoonfuls of essence 
of pepsin. 

Method. —Heat milk to 100° F.; add pepsin; whip lightly 
with a fork to separate the curd; strain through a fine 
strainer. Serve cold. 


BEVERAGES AND FLUID FOODS 


429 


MILK-PUNCH 

Ingredients: i pint of milk, 2 teaspoonfuls of sugar, 2 
tablespoonfuls of brandy or sherry. 

Method.— Dissolve sugar in milk; add brandy; mix well, 
and serve. 

EGG BROTH 

Ingredients: 1 egg, J teaspoonful of sugar, 1 pint of 
boiling water, £ teaspoonful of salt. Milk may be used in¬ 
stead of water and a small piece of butter added if desired. 

Method. —Beat egg and sugar until very light; add boil¬ 
ing water, stirring all the time; add salt. Serve at once. 

EGG FLIP 

Ingredients: 1 egg, \ teaspoonful of sugar, 1 wine glass¬ 
ful of sherry or brandy. 

Method. —Beat yelk of egg and sugar until light and 
creamy; add spirits; beat white of egg till stiff; fold into 
mixture. Serve at once. Two tablespoonfuls of lemon 
juice may be used instead of spirits. 

koumiss 

Ingredients: 1 quart of milk, 2 tablespoonfuls of sugar, 

1 tablespoonful of warm water, \ cake of compressed yeast| 
three or four bottles with tight corks. 

Method. Heat milk to blood heat; add sugar and yeast 
dissolved in warm water, fill bottles three-quarters full; 
cork securely; invert; keep at a temperature of 80° or 
100° F. for six hours. Cool, and it is ready to serve. 

EGG-NOG 

Ingredients: 1 egg, 1 tablespoonfyl of sugar, 1 cupful 
of milk, 1 teaspoonful of vanilla or 1 tablespoonful of wine, 

1 tablespoonful of crushed ice. 

Method. —Beat egg and sugar until light; add milk; 
fold in stiffly beaten white; add flavoring; mix well; pour 
over crushed ice and serve. If wine is used, add ice-water 
before adding milk. May be served hot by omitting white 
of egg and heating milk. 


430 


INVALID COOKERY 


PEPTONIZED MILK 

Ingredients: \ pint of milk, 1 gill of water, 1 small 
tablespoonful of liquor pancreaticus, 20 grains of soda. 

Method .—Add water to milk; heat to 140° F. (do not 
boil). Add other ingredients; place in bottle; cork with 
absorbent cotton; keep in warm place for one hour, and 
put on ice. 

LABAN 

Ingredients: 2 quarts of sweet milk, i cake of com¬ 
pressed yeast, warm water enough to dissolve the yeast. 

Method. —Heat milk lukewarm (98° to 100° F.); dis¬ 
solve yeast in warm water; add to warm milk; put in warm 
place (even temperature of about 70° F.) for ten hours, 
then whip with Dover egg-beater or fork until very smooth. 
Put in jars and keep in cool place until needed. Save a 
cupful of mixture and use instead of yeast. The first 
may be too strong of yeast; if so, discard, and use a cupful 
of mixture and proceed as directed. 

COFFEE (PLAIN) 

Ingredients: 1 tablespoonful of coffee, \ pint of boiling 
water, 1 teaspoonful of white of egg. 

Method. —Mix coffee and egg; wet with cold water; add 
hot water; bring to boil; keep hot, but do not boil, for five 
minutes. Serve hot with cream or hot milk. 

Another Method. —Mix coffee and egg; add £ pint of cold 
water; bring to a boil; let stand on back of stove for five 
minutes to settle, then serve as above. 

French or filtered coffee is made by placing coffee in 
strainer in coffee-pot and pouring boiling water through 
until strong enough. 


COFFEE (BLACK) 

Ingredients: 1 cupful of ground coffee, 1 pint of water. 
Method. —Same as plain coffee, omitting the egg. It 
may be boiled for one minute; strain. Used as a stimu¬ 
lant in case of collapse. 


EGGS 


431 


MILK COFFEE 


Ingredients: 1 tablespoonful of ground coffee, i cupful 
of cold water, 1 cupful of hot milk. 

Method. Put coffee in coffee-pot; add water; bring to 
a boil; let stand for five minutes; strain; add hot milk 
serve at once. 


MALTED MILK (COLD) 

Ingredients: 1 tablespoonful of malted milk, I cupful 
of cold water, 1 tablespoonful of hot water. 

Method. Dissolve malted milk in hot water; add cold 
water; stir until well mixed or place in a soda-water 
shaker and shake until dissolved. A tablespoonful of hot 
coffee, cocoa, or flavoring of any kind desired may be 
used. J 


MALTED MILK ICE-CREAM 

Ingredients: 2£ tablespoonfuls of malted milk, 1 cupful 
of water, 1 tablespoonful of sugar, 1 tablespoonful of 
cream, \ teaspoonful of flavoring. 

Method .—Mix milk and sugar; dissolve in water; add 
cream and flavoring; stir well; freeze. White of an egg 
(stiffly beaten) may be added if a richer cream is de¬ 
sired. 


CHAPTER XLVII 

EGGS 
Lesson 2 

Protein and fats are the chief ingredients of eggs. 
Some mineral substances and water are found in them. 
The fat of eggs is found largely in the yelk. 

The albumen or protein of the egg is mostly found in 
the white part. 



432 


INVALID COOKERY 


The shell of the egg is porous and may absorb disagree¬ 
able odors. . . 

Eggs should not be placed in contact with onions, tish, 

kerosene, or other strong-smelling substances. 

Eggs kept in the ice-box will require a longer time to 
boil than if kept in a warm place. 

Hard-boiled eggs should be slowly and thoroughly mas¬ 
ticated. . , 

The yelk of the egg contains more nutriment than the 

white. . - 

Unless ordered, eggs should not be given in cases ot 
severe gastric derangement or in flatulent dyspepsia. 

When poaching eggs, if rings are used to hold them, 
the edges will be in better shape. Yelks of eggs may be 
saved by covering with cold water when not needed imme¬ 
diately. In that way they will keep soft and fresh, and 
may be used for custard or pudding and in various other 
ways in the kitchen. 

CODDLED EGGS 

Ingredients: 1 egg, 1 cupful of boiling water, i tea¬ 
spoonful of salt. 

Method .—Break the egg into egg-cup; add. salt; pour 
boiling water carefully over, and let stand six or eight 
minutes in a hot place; remove water very carefully. 
Serve at once in cup in which it is cooked. Strips of 
bread and butter arranged log-cabin fashion may be served 
with it. 

POACHED EGG IN MILK 

Ingredients: 1 egg, 1 cupful of hot milk, i teaspoonful 
of salt, 1 slice of toast. # 

Method .—Heat milk; add salt; drop egg, being care¬ 
ful not to break the yelk. Cook gently (do not boil) for 
five minutes. Toast bread a golden brown; cut in rounds; 
butter; place an egg on toast; pour remainder of milk over, 
garnish with parsley. Serve at once. 


EGGS 


433 


EGG COOKED IN SHELL 

Method .—Place egg in bowl on back of stove and pour 
boiling water over it; let stand covered from six to eight 
minutes if desired soft, and from twelve to fifteen minutes, 
if hard. 

CREAMED EGG 

Ingredients: 1 egg, J cupful of milk, \ tablespoonful 
of butter, \ teaspoonful of salt, 1 slice of toast. 

Method. Beat egg slightly; add salt; heat milk and 
butter in double boiler; add egg; cook until creamy (about 
three minutes, stirring all the time); toast bread a golden 
brown; remove crust; place egg on toast. Serve at once. 
Garnish with cress. 

EGG IN BATTER, OR SCALLOPED EGG 

Ingredients: 1 egg, 2 tablespoonfuls of cream, 2 table¬ 
spoonfuls of bread-crumbs, J teaspoonful of salt. 

Method. Mix cream, bread-crumbs, and salt. Butter 
an egg-cup; put one-half the mixture in cup, then the egg, 
cover with the remainder of mixture; bake five or six 
minutes in a moderate oven. Serve at once in cup used 
for baking. 

SHIRRED OR BAKED EGG 

Method. Break egg in buttered dish; add salt; bake 
in moderate oven until white is firm (about five minutes). 
Serve in same dish. Garnish with strips of bread and 
butter. 

SCRAMBLED EGGS ON TOAST 

Ingredients: 1 egg, 1 tablespoonful of milk, 1 teaspoon¬ 
ful of butter, J teaspoonful of salt, 1 slice of toast. 

Method .—Beat egg slightly; add milk and salt; melt 
butter in frying pan; add mixture; cook until creamy, 
stirring very gently. If rightly managed, it will be soft, 
creamy, and toothsome; if wrongly, tough and stringy. 
Toast bread a golden brown; roll crust; butter and moisten 
slightly; pour egg on toast; garnish with parsley. Serve 
at once. 


28 


434 


INVALID COOKERY 


POACHED EGG 

Ingredients: 1 egg, hot water, J teaspoonful of lemon 
juice or vinegar, 1 teaspoonful of butter, 1 slice of toast. 

Method.—Break egg in pan of water in which lemon 
juice is dissolved; cook without boiling until yelk is cov¬ 
ered with white film; remove carefully; place on buttered 
toast. Serve at once. 


EGG SOUFFLE 

Method .—Separate white and yelk; beat white till stiff; 
place in heavy tumbler; add salt; place glass in pan, ad 
warm water; place cloth in pan to set glass on; have the 
water about three-quarters up the glass; bring to a boil; 
cook until white rises to top of glass; make a depression 
in the center; drop the yelk in very carefully so as not to 
break; cook about two minutes or until the yelk is set; 
remove and serve at once, with strips of bread and butter. 

omelet 

Ingredients: 1 egg, 1 tablespoonful of butter, 1 table¬ 
spoonful of milk, 1 tablespoonful of bread-crumbs, i tea¬ 
spoonful of salt, a dash of pepper. 

Method .—Separate egg; beat white till stiff; cream yelk, 
add to bread-crumbs and milk; mix; add salt; fold in 
stiffly beaten white; place butter in well-cleaned omelet 
pan; heat; add mixture; cook on top of stove slowly until 
well risen; place on rack of oven until firm; remove care¬ 
fully to a hot plate; garnish with parsley. Serve at once. 
May be varied by using minced chicken or meat of any 
kind, or vegetables in place of bread-crumbs. 


EGG NESTS 

Ingredients: 2 eggs, 2 slices of toast. # 

Method .—Divide the whites and yelks of the eggs, being 
careful to keep the yelks unbroken; have the toast buttered 
and cut in rounds. It may be moistened with a little 
soup stock if desired. Use only one-half the whites of the 


EGGS 


435 


e gg s > beat to a stiff froth and heap on the rounds of toast. 
With the ends of the shell make a hollow in the center of 
the mound, drop in the yelk, sprinkle with salt and pepper. 
Drop on some tiny pieces of butter and set on the top shelf 
of an oven not too hot. The heat should allow for the egg 
to be in the oven at least four minutes before browning. 
The toast may be sprinkled with grated cheese or finely 
minced meat. Tomato sauce may also be served with it. 

RICE OMELET 

Ingredients: J teacupful of cold boiled rice, J cupful 
of milk, 1 teaspoonful of melted butter, 1 egg, salt as 
needed. 

Method .—Warm the cold boiled rice in the milk and add 
the melted butter; beat yelk and white of egg separately; 
stir the yelk into the other ingredients, and, lastly, fold in 
stiffly beaten whites; pour into a very hot, well buttered, 
individual frying pan; let it brown for one minute; put on 
the top of the oven to set the top, and fold and serve as 
usual. 

PLAIN OMELET 

Method. Put 2 eggs into bowl; add salt and pepper as 
desired; beat vigorously for twelve minutes with fork, and 
add 1 tablespoonful of milk or cream. 

Into a small hot frying pan put a teaspoonful of butter; 
pour in the egg and shake over the fire till it is set; roll, 
and serve on a hot dish. Grated cheese or minced chicken 
or ham may be spread over before rolling it. 

ox EYES 

Method .—Take 2 slices of bread 1 inch thick; cut in 
rounds, and cut a circle about 1J inches in diameter out 
of the center with a sharp tin cutter; spread lightly with 
butter; place in baking pan; break a fresh egg into each 
circle; put little bits of butter over the egg, and season 
with salt and pepper; moisten with a tablespoonful of 
sweet cream or rich milk, and put into the oven till the eggs 
are lightly set. 


436 


INVALID COOKERY 


CHAPTER XLVIII 
SEMISOLID FOODS 
Lesson 3 

Potatoes and most cereals contain large quantities of 
starch. Other substances containing much starch are 
arrowroot, tapioca, sago, and corn. 

Farinaceous foods are a subdivision of starchy foods, 
and include rice, tapioca, etc. In a farinaceous diet milk 
and butter are usually added and all other animal foods 
excluded. 

Milk-diet consists of from 2 to 3 quarts of milk per day, 
all other foods excluded. 

Nitrogenous diet consists mainly of animal foods. Foods 
yielding sugars and starches are excluded, excepting some¬ 
times dried or brown bread or toast. 

Thorough cooking of starchy foods is very important. 
Cooking causes the bursting of the outer envelope which 
encloses the starch granules, making them soluble and 
fit for digestion. These granules are insoluble in cold 
water. 

The first stage in the digestion of starchy foods begins 
in the kitchen. 

The need of thorough mastication of starchy foods 
should be impressed on every invalid. 

CEREALS 

RICE 

Ingredients: 2 tablespoonfuls of rice, 1 pint of boiling 
water, \ teaspoonful of salt. 

Method .—Wash rice; slowly scatter in boiling water; 
add salt; cook in double boiler about one hour or until 
tender; the kernels should be distinct. Serve hot with 
cream and sugar. 


SEMISOLID FOODS 


437 


CREAM OF WHEAT 

Ingredients: 1 tablespoonful of cream of wheat, 1 cup¬ 
ful of boiling-water, | teaspoonful of salt. 

Method. Scatter wheat in salted boiling water, stirring 
constantly to prevent lumping; cook in double boiler for 
one-half hour. Serve hot with cream and sugar. All 
fine cereals may be cooked in this way. 

HOMINY 

Ingredients: 1 tablespoonful of fine hominy, 1 cupful 
of boiling water, \ teaspoonful of salt. 

Method. —Scatter hominy in salted boiling water; cook 
in double boiler for one hour. Serve hot with cream or 
butter and sugar. 

OATMEAL OR CORNMEAL MUSH 

Ingredients: 1 tablespoonful of meal, 1 cupful of boil¬ 
ing water, J teaspoonful of salt. 

Method. —Scatter meal in salted boiling water; cook 
in double boiler for at least one hour. If cornmeal is 
used, moisten with cold water before adding to the boiling 
water, and cook. Serve hot. 

OATMEAL GRUEL 

Ingredients: 2 tablespoonfuls of oatmeal, 3 cupfuls of 
water, \ teaspoonful of salt, \ cupful of hot milk. 

Method. —Soak oatmeal over night in the water; in the 
morning add salt; cook in double boiler for two hours; 
strain; add hot milk. Serve either hot or cold. 

FLOUR GRUEL 

Ingredients: 1 tablespoonful of flour, 1 cupful of hot 
milk, J teaspoonful of salt. 

Method. —Mix flour and salt; add cold water to make a 
thin paste; add to hot milk; cook in double boiler for one- 
half hour. Serve hot or cold. 


438 


INVALID COOKERY 


CRACKNEL OR CRACKER GRUEL 

Ingredients: 2 cracknel biscuits or crackers, 1 cupful of 
boiling water, 1 cupful of milk, i teaspoonful of salt. 

Method .—Brown cracknel in oven till a light brown; 
crush or roll fine; add salt; moisten with milk; cook in 
double boiler for five minutes. Serve hot. 

BAKED CUSTARD 

Ingredients: 2 cupfuls of milk, 2 eggs, 1 tablespoonful 
of sugar, £ teaspoonful of salt, a grating of nutmeg. 

Method .—Beat eggs slightly; add sugar, salt, and milk; 
mix well; pour in well-buttered custard cups; grate nut¬ 
meg over top; set in pan of water; bake in moderate oven 
until firm. Any flavoring desired may be used. Serve 
cold in cups in which they are baked. 

JUNKET (plain) 

Ingredients: 1 pint of milk, \ junket tablet, 1 teaspoon¬ 
ful of cold water, 2 tablespoonfuls of sugar, \ teaspoonful 
of vanilla or any flavoring desired. 

Method .—Dissolve tablet in water; heat milk to 100° F.; 
add sugar; stir until dissolved; add dissolved tablet and 
flavoring; stir well; pour in sherbet cups; set in warm 
place until firm; remove carefully to ice-box; serve cold, 
plain, or with whipped cream on top. May be varied by 
using different flavoring. Egg yelk may be added to 
milk before junket tablet is added, or meringue of the 
white of egg to top before serving. Cocoa may be used 
in place of one-half of milk. Fruit sauces may be used 
with junket for variety. Garnish with a few fresh berries 
in season when fruit is permissible. 

MILK-TOAST 

Ingredients: 2 thick slices of toast, 1 cupful of hot milk, 
4 teaspoonful of salt, a bit of butter. 

Method .—Remove crust and butter; place in hot bowl; 
pour hot milk over. Serve at once. May have sugar 
added if desired. 


SEMISOLID FOODS 


439 


BLANC MANGE 

Ingredients: 2 cupfuls of milk, 1 tablespoonful of corn¬ 
starch, teaspoonful of flavoring. 

Method.— Mix sugar and cornstarch; make into a 
smooth white paste with cold water; heat the milk in 
double boiler; add paste; stir until smooth; cook for ten 
minutes; remove from fire and add flavoring; pour in mold; 
set in cold place. Serve with whipped cream and sugar. 

GELATIN (plain) 

Ingredients: 1 tablespoonful of granulated gelatin, 2 
tablespoonfuls of cold water, 1 tablespoonful of sugar, 
1 cupful of boiling water, ^ tablespoonful of lemon juice. 

Method. —Soak gelatin in cold water for five minutes; 
add boiling water, sugar, and flavoring; stir until dis¬ 
solved; pour in mold; set in cold place until firm; serve 
cold with cream and sugar. Any flavor may be used. 
Fruit juice or coffee may be used in place of water, but 
should be hot before adding to the gelatin. 

BOILED CUSTARD (THIN) 

Ingredients: 1 pint of milk, 1 teaspoonful of corn¬ 
starch, \ teaspoonful of flavoring, J cupful of sugar, a 
dash of salt, 1 egg. 

Method. —Heat milk in double boiler; blend sugar and 
cornstarch; add to heated milk; cook until it thickens; 
remove from fire; add well-beaten egg and salt and flavor¬ 
ing. If wanted thicker, add more cornstarch. If desired, 
may be served with sliced oranges or bananas. 

MALTED MILK BLANC MANGE 

Ingredients: 2 tablespoonfuls of malted milk, 2 table¬ 
spoonfuls of arrowroot, 1 tablespoonful of sugar, 1J cup¬ 
fuls of water, J teaspoonful of vanilla. 

Method. —Mix milk and arrowroot; add water to make 
smooth paste; add sugar, flavoring, and the rest of water; 
boil until it thickens, stirring all the time. Serve either 
hot or cold with cream. 


440 


INVALID COOKERY 


MALTED MILK CUSTARD 

Ingredients: 2 tablespoonfuls of malted milk, 1 cupful 
of water or milk, 1 tablespoonful of sugar, yelks of 2 eggs, 
a pinch of salt. 

Method .—Mix malted milk, sugar, salt; add water; stir 
until dissolved; add well-beaten egg yelks; pour in but¬ 
tered cups; grate nutmeg over; bake in pan of water in 
moderate oven until set (about twenty minutes). Serve 
cold in cup in which it is baked. 


CHAPTER XLIX 

SOUPS AND PUREES 
Lesson 4 

The water in which meat is boiled is termed broth or 
bouillon. 

ConsommS is a clear soup made from beef or mutton. 
Clear broth contains certain salts and soluble extractives, 
some gelatin, little or no albumin, and very little nutri¬ 
tious substance. It is slightly stimulating to the digestive 
organs. 

In preparing soup stock, prolonged cooking is necessary 
to fully extract the gelatin. The floating coagulated 
albumin is skimmed off with the fat or strained. 

Puree is strained, thickened vegetable soup. 

If meat is cut into small pieces, put into cold water, 
the temperature raised gradually to 160° F., and actual 
boiling avoided, more of the albumin will be extracted. 

The method of cooking determines largely the amount 
of the soluble constituents that will be extracted from the 
meat. 

Soups are thickened with flour, cornstarch, or rice- 
flour. Cornstarch gives a smooth, more velvety soup 
than flour. 



SOUPS AND PUREES 


441 


The soup should always boil at least twelve to fifteen 
minutes after the thickening is added, that the starch may 
be thoroughly cooked. 

A thickened soup should be about the consistency of 
good cream. Purees are thicker. 

A tablespoonful of flour to 1 quart of soup is the rule, 
and the amount of cornstarch slightly less. 

Sago, tapioca, rice, or farina may be used instead of the 
flour or cornstarch, but require longer cooking. 

CLAM BROTH 

Ingredients: \ dozen of fresh clams, 1 cupful of water, 
1 cupful of milk, \ teaspoonful of salt, a bit of butter, a 
dash of pepper. 

Method .—Wash clams; cut in small pieces; add water 
and salt; bring to a boil; skim; add milk, butter, pepper; 
bring to a boil; strain if patient may not have the clam 
meat. Serve hot with toast or crackers. 

OYSTER BROTH 

Ingredients: J cupful of oysters, 1 cupful of water, J tea¬ 
spoonful of salt, a dash of pepper. 

Method .—Wash oysters; place in saucepan; heat; skim; 
add water, salt, and pepper; bring to a boil. Serve very 
hot with oysterettes. 

Oyster stew is made without cutting the oysters, and 
using milk, crumbs, crackers, and 1 teaspoonful of butter. 
Serve hot, as above. 

BEEF OR MUTTON BROTH 

Ingredients: 2 pounds of lean beef or mutton (shank 
of beef or neck of mutton), 2 quarts of cold water, 1 tea¬ 
spoonful of salt, 3 tablespoonfuls of rice or barley, 2 bay 
leaves, 1 stalk of celery. 

Method .—Wipe meat with damp cloth; remove fat and 
skin; cut in pieces; break the bones; place all in soup kettle; 
add salt and cold water; heat gradually to the boiling- 


442 


INVALID COOKERY 


point, but do not boil; skim as scum rises to the top; 
simmer for three or four hours; strain; cool; remove all 
fat; add rice, celery, bay leaf, and cook until rice is soft, 
but do not boil. Serve hot with croutons or wafers. 

CHICKEN JELLY 

Ingredients: \ chicken or fowl, 1 quart of cold water, 
^ bunch of parsley, 1 teaspoonful of salt, 2 stems of celery. 

Method. —Clean, wash, and skin chicken; cut in small 
pieces, being sure to use all the bones; place in stew pan; 
add celery, the stems of the parsley, but not the leaves; 
salt; pour cold water over all; simmer (do not boil) until 
the chicken falls to pieces; strain; stand over night or 
until cold; remove fat. Should be clear, firm jelly. 

CHICKEN MILK 

Ingredients: 1 cupful of chicken jelly, 1 cupful of milk. 

Method .—Place in stew pan and bring to boil. Serve 
hot with strips of toast, or may be served cold in jelly form. 

TAPIOCA CREAM SOUP 

Ingredients: 1 pint of stock, 1 cupful of cream or milk, 
1 heaping tablespoonful of tapioca, 1 small onion, 1 stalk 
of celery, 2 teaspoonfuls of butter. 

Method .—Wash and soak the tapioca and cook in just 
sufficient water to keep from burning for one hour; cut 
onion and celery into small pieces and cook for twenty 
minutes in the stock, add the milk to the stock; stir in 
the tapioca; add butter, salt, and pepper; simmer slowly 
until tapioca is thoroughly cooked. 

CREAM OF TOMATO 

Ingredients: 2 tablespoonfuls of tomato juice, \ cupful 
of milk, 1 tablespoonful of flour or bread-crumbs, 1 table¬ 
spoonful of butter, \ teaspoonful of salt, ^ teaspoonful of 
soda, a dash of pepper. 


SOUPS AND PURGES 


443 


Method. Heat tomato juice; add soda; heat milk; add 
butter, flour, salt, and pepper. When ready, serve at 
once with croutons or crackers. 

CELERY BISQUE 

Ingredients: 1 cupful of white sauce, 1 stalk of celery, 
1 cupful of water. 

Method. Cut celery fine; cook in salted water until 
tender; mash fine; add white sauce; heat. Serve at once 
with bread sticks. A few oysters are a desirable addition. 

CREAM OF SPINACH 

Ingredients: 1 pint of spinach or 1 tablespoonful of 
spinach juice, 1 cupful of white sauce, { teaspoonful of beef 
extract, J teaspoonful of onion juice. 

Method. —Pick over the spinach and wash thoroughly; 
place in stew pan and cook for fifteen minutes without 
cover, stirring occasionally; strain; heat white sauce; 
add extract and onion juice. Serve at once with wafers. 

croutons 

Method. —Cut stale bread in 1 inch cubes, removing 
crust; melt 1 tablespoonful of butter in pan; add bread 
cubes; shake well; toast a golden brown in oven. May be 
prepared in quantities, as they will keep in a closed can 
indefinitely. Heat when used. 

CONSOMM^ WITH MACARONI 

Ingredients: 1 cupful of consommS, 1 tablespoonful of 
cooked macaroni. 

Method. —Heat consomme and macaroni. Serve hot 
with wafers. 

VEGETABLE PUR^E 

Ingredients: 1 ounce of suet or olive oil, 1 tablespoonful 
of chopped carrot, 1 tablespoonful of chopped turnip, 1 
tablespoonful of celery, 1 tablespoonful of chopped potato, 

1 thin slice of onion, 1 bay leaf, 1 cupful of white sauce, 

1 tablespoonful of rice, 2 cupfuls of boiling water. 


444 


INVALID COOKERY 


Method. —Place suet or oil in saucepan; when hot add 
vegetables and bay leaf; brown, stirring all the time; add 
well-washed rice and hot water; simmer slowly until vege¬ 
tables are very tender; strain through puree strainer; add 
white sauce; bring to a boil. Serve at once with croutons. 

PUR^E OF POTATO 

Ingredients: 3 tablespoonfuls of hot mashed potato, 
1 cupful of white sugar, J teaspoonful of onion juice. 

Method. —Heat white sauce; add mashed potato and 
onion juice; bring to a boil. Serve at once with bread 
sticks or crackers. 

PEA PUREE 

Ingredients: 1 cupful of peas (fresh or canned), 1 cup¬ 
ful of white sauce, l teaspoonful of sugar. 

Method. —Cook peas until tender; if canned ones are 
used, drain and rinse off peas before adding fresh water 
to cook; press through strainer; add white sauce and sugar; 
bring to a boil. Serve at once with croutons or wafers. 

CORN SOUP 

Ingredients: \ cupful of corn, 1 cupful of water, 1 cup¬ 
ful of white sauce, \ teaspoonful of onion juice, yelk of 1 

egg- 

Method. —Cook corn in water until tender; strain 
through strainer; add white sauce and onion juice; bring 
to a boil; pour over smoothly beaten yelk, stirring all the 
time. Serve at once with wafers. 

BREAD STICKS 

Method. —Cut bread in strips about 3 or 4 inches long 
and \ inch square. Toast in oven a golden brown. 

CREAM OF ASPARAGUS 

Ingredients: 1 small bunch of asparagus, 1 cupful of 
white sauce, 1 cupful of white stock, \ teaspoonful of onion 
juice, J teaspoonful each of salt and pepper. 


SOUPS AND PUREES 


445 


Method— Soak asparagus in cold salted water for one- 
half hour; drain; cut in small pieces; place in soup kettle; 
add stock; cook slowly until very tender; remove a few of 
the best tips before being boiled to pieces; strain through 
vegetable strainer; return to kettle; add white sauce, 
onion juice, salt, and pepper; bring to a boil. Serve with 
tips placed on top. 

RICE soup 

Ingredients: 2 tablespoonfuls of rice, 1 cupful of milk, 
1 tablespoonful of butter, ^ teaspoonful of onion juice, 
i teaspoonful of celery, salt, a small bay leaf, dash of 
pepper. 

Method .—Wash rice; put in double boiler, cook until 
very tender; add butter, onion juice, celery, salt, bay leaf, 
pepper; cook for fifteen minutes. If too thick, add hot 
milk and bring to a boil. Serve hot with bread sticks. 


VICTORIA SOUP 

Ingredients: 1 tablespoonful of minced chicken, ^ cup¬ 
ful of chicken broth, i cupful of milk, 1 tablespoonful of 
cracker crumbs, 1 hard-boiled egg, J teaspoonful of salt, 
a dash of pepper. 

Method. Soak crumbs in milk; mince chicken very 
fine; add to crumbs; add powdered yelk, salt, pepper, and 
broth; place all in double boiler and cook for one-half 
hour. Serve hot with croutons. 


OYSTER SOUP 

Ingredients: 1 cupful of oysters, 1 cupful of hot milk, 
1 teaspoonful of butter, 1 teaspoonful of cracker crumbs, 
i teaspoonful of salt, } teaspoonful of pepper. 

Method .—Wash oysters; place in saucepan with the 
liquor; bring to a boil; skim; add hot milk, butter, salt, 
pepper, cracker crumbs; bring to a boil. Serve at once, 
very hot, with oysterettes. Watch carefully, as the soup 
burns readily. 


446 


INVALID COOKERY 


puree of carrots 

Method .—Prepare sufficient red carrots to make 14 cup¬ 
fuls when sliced; parboil for ten minutes: drain and boil 
till tender in just sufficient water to keep from burning; 
season with salt and pepper; add 1 pint of beef or chicken 
broth or milk and 1 cupful of stale bread-crumbs: s i mm er 
for one-half hour and pres through a puree sieve. If 
too soft, let cook a little longer; if too dry, add a little 
broth or milk. Serve with lamb chops or veal cutlets. 

PUREE OF LIMA BEANS 

Method .—Soak 1 teacupful of lima beans over night; 
boil in water or stock or the thin part of a can of tomatoes? 
until the beans are soft, using only enough fluid to keep 
from burning. Salt, pepper, a little onion juice, or any 
other seasoning preferred may be added: press through a 
sieve. Rub 2 teaspoonfuls of flour into the same amount 
of melted butter till the flour is smooth: pour slowly over 
this 4 cupful of boiling stock, stirring vigorously. and add 
this to the remainder of the soup; cut tomatoes into thin 
slices, or an equal amount of the solid part of canned 
tomatoes, and drop into the soup. Let it boil up once and 
serve. 


CHAPTER L 

TOAST, SAXDWICHES, AXD WAFERS 
Lessor. 5 

White bread yields the highest amount of digestible 
nutriment, entire wheat ranks next, and Graham flour last. 

The coarser flour with particles of bran acts as a stimu¬ 
lant to peristalsis- 



TOAST, SANDWICHES, AND WAFERS 


447 


Stale bread and dry toast are more easily digested than 
fresh bread. 

All foods should be eaten slowly and thoroughly masti¬ 
cated, so that the saliva may be thoroughly mixed with 
the starch. 

Bread for toasting should be cut in rather thin slices. 

The object of toasting is to extract the moisture, im¬ 
prove the flavor, and increase the digestibility. 

The addition of butter makes it more palatable and 
supplements it as a food by furnishing the fat, which the 
body needs. The toast should be evenly done and dried 
before browning. 

Gluten is the principal nitrogenous ingredient of wheat. 
It has a high nutritive value and is easily digested. Gluten 
is flour from which the starch has been separated. 

Make crackers crisp before serving by placing in a moder¬ 
ate oven for a few minutes. 

All bread is much more appetizing if cut thinly and 
evenly, rather than rough and thick on one end and thin 
on the other. 

Butter should be molded in balls or cut in cubes, never 
served in a slovenly manner. 

The crust of toast should be removed or else rolled 
before buttering. 

Care should be taken that toast is a golden brown, not 
burned on one end and white on the other, not soaked 
with melted butter, nor the butter dabbed on in patches. 

BAKED TOAST 

Method .—Prepare slices of stale bread by cutting off 
the crust and toasting to a light brown. Have ready a 
dish of boiling water well salted. Dip each slice into the 
salted water and then butter it; arrange in baking dish; 
cover with boiling milk, and bake for fifteen minutes. Add 
cream to the milk if it is available. 

Water-toast may be made by omitting the milk, the 
toast being served between hot plates after being dipped 
in water and buttered. 


448 


INVALID COOKERY 


CREAM-TOAST 

Ingredients: 3 small slices of bread toasted, 1 teaspoon- 
ful of butter, 1 tablespoonful of cornstarch, 1 cupful of 
milk, \ teaspoonful of salt. 

Method .—Have the toast buttered; cut in small squares 
with crust rolled or removed; place it in hot deep basin or 
soup plate; let the milk come to a boil and add the butter; 
blend the cornstarch with a little water; stir it into the 
milk, and cook for five minutes in a double boiler, stirring 
until smooth. Pour over the toast, and serve at once. 

MILK-TOAST 

Method .— 1 Toast 2 slices of bread evenly; cut in neat 
squares, removing the crust, and place in a deep basin, 
which should first be heated; have ready also a hot saucer 
or plate to cover it; prepare the tray with a small knife, 
fork, and teaspoon, a little silver pot of hot milk, a ball of 
butter, and a salt shaker. If the patient is able to butter 
his own toast and pour the hot milk, he will usually enjoy 
doing it. If not, the toast should be buttered, and the 
milk added when ready to be eaten. Bouillon or con¬ 
somme may be used instead of milk. 

CLAM-TOAST 

Method .—Chop a dozen small clams into small pieces 
and simmer for a few minutes; beat the yelk of 1 egg with 
2 tablespoonfuls of milk; pour it over the clams; let it 
come almost to the boiling-point, and pour over hot but¬ 
tered toast. Lean ham may be minced, cooked, and served 
in the same way, a little butter and chopped parsley being 
used for seasoning. 

TOMATO-TOAST 

Method .—Peel and chop 1 ripe tomato; mince about 
1 ounce of ham, a small onion, and cook all in about 1 
tablespoonful of butter and a little water for about ten 
minutes. Stir into this a well-beaten egg; let it remain 
over the fire till it sets, and pour over hot toast. 


TOAST, SANDWICHES, AND WAFERS 


449 


meat sandwiches 

Ingredients: \ cupful of minced chicken or cold meat 
of any kind, 1 tablespoonful of cream, 2 slices of bread 
buttered. 

Method. Butter bread before cutting; remove crust; 
cut in fancy shapes, as stars, triangles, etc., spread with 
mixture, and place together. Serve wrapped in napkin. 

LETTUCE AND EGG SANDWICH 

Ingredients: 1 hard-boiled egg yelk, 1 tablespoonful of 
cream, 1 tablespoonful of French dressing, lettuce leaves 
2 slices of bread, butter. 

Method. Cream yelk; add cream; prepare bread as 
above; spread with mixture; wash lettuce and add to 
bread. Serve, garnished with cress. 

CELERY AND NUT SANDWICH 

Ingredients: £ cupful of chopped celery, 3 stoned olives, 

1 tablespoonful of minced English walnuts, 1 tablespoon¬ 
ful of dressing, 2 slices of bread, butter, and salt. 

Method. —Chop ingredients fine; mix smooth with 
dressing; proceed as usual. 

EGG SANDWICH 

Ingredients: 1 hard-boiled egg, J teaspoonful of salt, 

1 tablespoonful of butter, £ teaspoonful of mustard, £ tea¬ 
spoonful of vinegar, 2 slices of bread, butter, a few nas¬ 
turtium leaves. 

Method. —Mince the egg very fine; add other ingredients; 
mix well; prepare bread as usual; spread mixture on, then 
sprinkle with minced cress or nasturtium leaves; cover. 
Serve, garnished with nasturtium leaves, and blossoms. 

SCRAPED BEEF SANDWICH 

Ingredients: 1 tablespoonful of scraped raw beef, J tea¬ 
spoonful of salt, a dash of pepper, 2 slices of bread, butter. 

29 


450 


INVALID COOKERY 


Method .—Scrape beef with a dull knife; add salt and 
pepper; mix well, and proceed as usual; cut bread in 
strips; pile on plate log-cabin fashion. Serve, garnished 
with cress. Cover with doiley. 

PLAIN BREAD AND BUTTER SANDWICH 

Method .—Butter bread; cut thin; remove crust; cut in 
shape desired; may be toasted golden brown after making 
or may be varied by using brown bread for one side. Pea- 
nut butter may be used. 

BROWN BREAD SANDWICH 

Method .—Butter brown bread (baked in baking powder 
cans); cut thin; serve, garnished with cress or nasturtium 
leaves. 

FRUIT SANDWICH 

Method .—Butter bread as usual; then spread with 
minced figs, dates, prunes, mixed with a little lemon juice. 

SHREDDED WHEAT SANDWICH 

Method .—Cut biscuit in half; spread with apple-sauce 
or fresh berries or fruit of any kind. Serve with sweet or 
whipped cream. 


NEW YORK SANDWICH 

Method .—Butter 3 slices of bread (white), 2 of Graham; 
lay light, then dark, on top of one another alternately; 
press carefully together, then cut, like layer cake, in 
pieces \ inch wide. 

SOME SANDWICH FILLINGS 

Equal parts of chicken and ham, finely minced, seasoned 
with curry powder. Minced tongue and hard-boiled egg, 
seasoned with mustard. 

Minced hard-boiled egg, one sardine to every three, 
seasoned with lemon juice. 


451 


TOAST, SANDWICHES, AND WAFERS 


Water-cress, finely chopped, salt and pepper, and hard- 
boiled egg, chopped thoroughly. 

finely^ r ° aS ^ c ^^ c ^ en an( * cold cooked oysters, chopped 
Cold corned beef and green peppers, minced finely. 


MACAROONS 

White of 1 e 88’ i cupful of almond powder. 

Method. Mix powder and unbeaten white (should be 
quite stiff); when well blended, drop £ teaspoonful upon 
paper; do not butter paper; bake in moderate oven until 
a delicate brown; remove; turn upside down; moisten and 
remove paper. 

BRAN CRACKERS 

Ingredients: 1 cupful of bran, 1 cupful of flour, 3 table¬ 
spoonfuls of butter, £ teaspoonful of soda, £ teaspoonful 
of cream of tartar, a dash of salt, £ cupful of milk. 

Method .—Mix bran, flour, cream of tartar, and salt; add 
butter and cream; add soda dissolved in milk; add milk 
enough to make a stiff dough; roll very thin; cut in squares; 
bake in slow oven. Will keep a long time in a tin box. 


GUM GLUTEN WAFERS 

Ingredients: £ cupful of sweet milk, £ teaspoonful of 
salt, gum gluten, flavor. 

Method. Add salt to milk; then add enough gum gluten 
flour to make a stiff dough; roll very thin; cut into strips; 
bake in slow oven until a light brown. 

GUM GLUTEN MUFFINS 

Ingredients: 1 cupful of gum gluten flour, 1 cupful of 
milk, £ teaspoonful of salt, £ teaspoonful of baking pow¬ 
der, 1 egg. 

Method. Beat egg smooth, add to milk; add gum 
gluten flour, salt, and baking powder, sifted together; 
mix thoroughly; bake in gem pans in a moderate oven for 
about twenty minutes. 


452 


INVALID COOKERY 


GUM GLUTEN BISCUITS 

Ingredients: 1 cupful of gum gluten flour, 1 tablespoon¬ 
ful of butter, £ teaspoonful of baking powder, £ teaspoon¬ 
ful of salt, about £ cupful of milk, or enough to make a 
soft dough. 

Method. —Mix dry ingredients; rub in the butter; add 
milk, enough to make a soft dough; roll about 1 inch thick; 
cut with biscuit cutter; bake in a quick oven for about 
fifteen minutes. 

WHEAT WAFERS 

Ingredients : 1 cupful of Vitos or cream of wheat, 2 
tablespoonfuls of butter, £ cupful of milk, 1 tablespoonful 
of sugar, £ teaspoonful of salt, £ teaspoonful of baking 
powder. 

Method. —Cream sugar and butter; add milk, then dry 
ingredients; mix well; roll thin on floured board; cut in 
fancy shapes; bake in moderate oven until light brown. 

OATMEAL WAFERS 

Ingredients: £ cupful of rolled oats, £ cupful of fine oat¬ 
meal, £ cupful of flour, 1 tablespoonful of sugar, 2 table¬ 
spoonfuls of butter, £ teaspoonful of salt, £ teaspoonful of 
baking powder, hot water, or sour milk with £ teaspoonful 
of soda added, enough to make a stiff dough. 

Method.— Mix dry ingredients; cream with the butter; 
add hot water to make a stiff dough; roll very thin on 
floured board; cut in strips; bake in moderate oven a gol¬ 
den brown. 

OATMEAL TEA CAKES 

Ingredients: 2 cupfuls of oatmeal, 1 cupful of flour, 
£ cupful of sugar, £ cupful of butter, 1 teaspoonful of 
baking powder, £ teaspoonful of nutmeg, £ cupful of milk, 
a dash of salt. 

Method. —Mix dry ingredients; rub in the butter, add 
enough milk to make a stiff dough; roll very thin, cut in 
fancy shapes; bake in moderate oven a light brown. 


TOAST, SANDWICHES, AND WAFERS 


453 


PLAIN CAKE 

Ingredients: £ cupful of sugar, £ cupful of milk, 1 table¬ 
spoonful of butter, } cupful of flour, 1 teaspoonful of bak- 
ing powder, £ teaspoonful of flavoring, 1 egg, a dash of 
salt. 

Method. Cream butter and sugar; add well-beaten 
yelk, milk, and flavoring; flour and baking powder, 
sifted together; fold in stiffly beaten whites; place in but¬ 
tered pan; bake in moderate oven for about one-half 
hour; or may be baked in layers and put together with 
whipped cream; or bake in gem pans and ice with plain 
or chocolate icing, with an almond on the top of each. 

BROWN BREAD 

Ingredients: £ cupful of buttermilk, £ cupful of molas¬ 
ses, 1 cupful of Graham flour, £ cupful of white flour, £ tea¬ 
spoonful of soda, a dash of pepper. 

Method. Dissolve soda in molasses; add buttermilk 
and flour of both kinds; beat well; place in well-buttered 
baking-powder cans; bake (covered) in a slow oven for 
about one hour. Serve either hot or cold. 

CORNMEAL GEMS 

Ingredients: 1 cupful of cornmeal, £ cupful of flour, 

1 tablespoonful of sugar, 1 tablespoonful of butter, 2 tea¬ 
spoonfuls of baking powder, £ teaspoonful of salt, £ cup¬ 
ful of milk, £ egg. 

Method. —Sift dry ingredients together, rub in the butter; 
add milk and well-beaten egg; beat smooth; bake in shallow 
pan or in gem pans in a quick oven about one-half hour 
or until a golden brown. Serve hot, rolled in a napkin. 

WHOLE WHEAT PUFFS 

Ingredients: 1 egg, £ cupful of sweet cream, 1 cupful 
of skimmed milk, 1 pint of flour. 

Method. —Separate the white and yelk of the egg and 
beat the white to a stiff froth; beat the yelk, and add to it 


454 


INVALID COOKERY 


i cupful of thin sweet cream and 1 cupful of skimmed 
milk. Mix these together thoroughly until foamy with 
air bubbles. Then add, gradually beating at the same 
time, 1 pint of flour; continue to beat vigorously for ten 
minutes, then stir in lightly the stiff white. Do not beat 
after adding the white. Have the gem pans hot, fill 
each one, and bake. If rightly made, these are quite as 
light as bread made with yeast. 



MEATS AND FISH 


455 


CHAPTER LI 

MEATS AND FISH 
Lesson 6 

It is impossible to make a rich broth and have a juicy, 
highly flavored piece of boiled meat at the same time. 

If the object is to cook by boiling, the meat should be 
placed in boiling water. This coagulates the albumin 
on the surface and a coating is formed. 

Two conditions are essential to successful roasting— 
a good fire and frequent basting. 

In boiling, the object is to coagulate as quickly as pos¬ 
sible all the albumin on the surface and seal up the 
pores of the meat, so as to retain its juices and flavors. 

By proper stewing the coarsest meat may be rendered 
tender and digestible. 

The smaller the cut to be roasted, the hotter the fire 
should be for the first ten minutes. 

The value of meat as a food depends not on the amount 
of nutriment contained, but the amount the individual 
patient can digest and assimilate. 

ROAST CHICKEN 

Method .—Clean and wash chicken; rub well with salt 
inside and out; stuff if desired; bake in covered roasting 
pan, with a little stock, about one hour for a young 
chicken; baste often; remove cover, and brown when 
tender. 

CREAMED CHICKEN 

Ingredients: 1 cupful of minced cold chicken, 1 cupful 
of white sauce, 1 slice of toast. 

Method .—Mince chicken; add white sauce; heat; pour 
over toast. Serve on hot plate. Garnish with cress or 
parsley. 

BROILED STEAK OR CHOPS 

Ingredients: \ pound of steak or chops, J teaspoonful 
of salt, 1 teaspoonful of butter, a dash of pepper. 


456 


INVALID COOKERY 


Method .—Remove all fat; wipe with damp cloth; broiling 
may be done over a clear fire of coals or gas; heat broiler; 
place meat on it; hold over the coals; count ten; turn 
without breaking the meat, continue turning and counting 
until done. If steak is 1 inch thick it should be done 
in eight to ten minutes. Place on hot plate; add butter, 
salt, and pepper. Garnish with parsley. Serve at once. 
All steak should be broiled; if impossible to use broiler, 
it may be pan-broiled. Have frying pan hot; place steak 
in, turn as if broiling in broiler. A little salt may be put 
in pan and browned before steak is put in, but in no case 
fat. The steak will not stick if the pan is clean and hot. 
It should be very hot when the meat is put in. 

CHOPS BROILED IN PAPER CASES 

Method .—Remove fat; wrap chop in buttered white 
paper and broil in broiler as usual (being careful not to 
ignite the paper); remove the paper; season. Serve on 
hot plate. Garnish with a spoonful of hot peas and pars¬ 
ley. 

STEWED OR FRICASSEED CHICKEN 

Ingredients: 1 chicken, 1 pint of milk, 1 teaspoonful of 
salt, 2 tablespoonfuls of flour, 1 tablespoonful of butter. 

Method. —Clean, joint, and wash chicken; wipe dry; 
place in saucepan in which butter has been melted; brown 
slightly; add enough hot water to cover; bring to a boil; 
skim; simmer until tender, from one to two hours. Salt 
when half done; remove from pan and bring to a golden 
brown in oven if fricassee is desired. If simply stewed, 
add milk and flour made to paste with cold water. Serve 
on hot plate with toast. 

CREAMED SALT CODFISH 

Ingredients: £ cupful of shredded codfish, 1 cupful of 
white sauce, yelk of 1 egg, 1 slice of toast. 

Method .—Soak codfish in cold water for one or two 
hours; drain; place in saucepan with white sauce; heat; 


MEATS AND FISH 


457 


remove from fire; add smoothly beaten yolk, stirring all 
the time. Serve over toast or in timbale cases. Garnish 
with parsley. 

ROASTED PARTRIDGE OR QUAIL 

Method. Clean and bone (that is, remove first joint of 
leg). Place in cold salt water for one hour; wipe dry; 
stuff if desired; lard with a slice of bacon fastened on with 
cord or skewer; roast a golden brown in covered pan; 
remove bacon. Serve on hot plate in a bed of rice or 
cress with strips of toast. Any bird may be roasted in 
this way. 

Birds may be broiled the same as steak or in paper 
cases. Split bird through the back; wipe dry; rub with 
softened butter, salt, and flour; broil for ten minutes. 
Serve on toast on hot plate. Garnish with parsley and 
currant jelly. 

BACON 

Method .—Cut very thin; fry crisp by commencing 
slowly and increasing the heat, or place pan on rack of 
moderate oven. Serve hot, drained of all fat. 

CREAMED SWEETBREAD 

Ingredients: 1 sweetbread, 1 cupful of white sauce. 

Method .—Cover sweetbread with cold water for one 
hour; drain; remove fat and membranes; place in acidu¬ 
lated water; simmer slowly for twenty minutes; drain and 
plunge into cold water; remove at once; cut in i-inch 
cubes; add white sauce; bring to a boil. Serve over toast. 
Garnish with parsley or cress. 

Acidulated water: £ tablespoonful of salt, 1 tablespoon¬ 
ful of vinegar, 1 pint of hot water. 

ROAST BEEF OR MUTTON 

Method .—Wipe roast with damp cloth, rub well with 
salt. The important point in roasting is the way you start. 
Have the fire hot at first, sear the roast on the cut ends 
by heating the pan hot, then place roast in and brown. 


458 


INVALID COOKERY 


Then place in a roasting pan and roast in oven (covered), 
allowing fifteen to twenty minutes for each pound of meat. 

Mutton does not need as hot a fire at first as beef. 

FRIZZLED BEEF 

Ingredients: J pound of dried beef, 1 cupful of white 
sauce, 1 tablespoonful of butter, 1 slice of toast. 

Method .—Mince beef fine; place in frying pan with 
butter; fry a golden brown; add white sauce; bring to a 
boil; pour over toast. Serve on hot plate at once or in 
timbale cases. 

BAKED FISH 

Ingredients: 1 fresh fish, 1 tablespoonful of bread¬ 
crumbs, 1 tablespoonful of butter, 1 teaspoonful of salt, \ 
cupful of stock, 1 slice of lemon, 2 slices of bacon. 

Method. —Clean, wash, and remove head (see that all 
scales are removed); rub well outside and in with salt and 
butter. Stuff if desired. Lard with bacon; place in a 
well-buttered fish pan; sprinkle bread-crumbs over; add 
stock; bake (covered) for about one hour; baste often; 
remove cover and brown. Serve on hot plate. Garnish 
with shavings made from a long red carrot and a white 
turnip. Serve lemon with fish. Any fish may be baked 
in this way. White, shad, salmon, and pike are con¬ 
sidered best for baking. 

SCRAPED BEEF-BALLS 

Method .—Scrape steak until all the soft part is removed; 
add salt; make into balls about the size of marbles; pan¬ 
broil as directed for pan-broiled steak for about two or 
three minutes. Serve on hot plate. Garnish with 
parsley. 

MUTTON WITH OYSTERS 

Ingredients: \ cupful of minced mutton, 1 tablespoonful 
of minced oysters, 1 tablespoonful of minced celery, \ cup¬ 
ful of stock, \ teaspoonful of onion juice, £ teaspoonful of 


MEATS AND FISH 


459 


salt, 1 tablespoonful of butter, 1 tablespoonful of flour, 
a dash of pepper. 

Method .—Mince mutton, removing all bone or gristle; 
cook celery till tender in a little water; drain; add mutton, 
oysters, stock, salt, onion juice, pepper; cream flour and 
butter; add to mixture; mix well; cook until it thickens, 
stirring all the time. Serve on hot plate. Garnish with 
toast points. 

SALMON LOAF 

Ingredients: \ cupful of canned salmon, 1 tablespoonful 
of bread-crumbs, £ cupful of milk, \ teaspoonful of celery 
salt, 1 teaspoonful of lemon juice, 1 egg, a dash of 
pepper. 

Method .—Drain fish; remove skin and bones; flake fine; 
add bread-crumbs, beaten yelk, milk, celery salt, lemon 
juice, pepper; mix well; fold in stiffly beaten white; pack 
in buttered cups; bake, covered (in a pan of water), for 
about fifteen minutes or until well risen. Remove cover 
and brown. Serve in bed of boiled rice or garnish with 
parsley, having bread sticks and a slice of lemon on side 
of plate. 

PANNED OYSTERS 

Ingredients: 1 cupful of oysters, 1 teaspoonful of butter, 
i teaspoonful of salt, a dash of pepper. 

Method .—Wash oysters; drain; place in saucepan; heat 
until the oysters are plump; add butter, salt, pepper; pour 
over toast. Serve at once. Garnish with bread sticks 
piled in log-cabin fashion around the edge of the plate. 
Serve a slice of lemon with the oysters if desired. 

FISH CAKES 

Ingredients: 1 cupful of fish, \ cupful of hot, mashed 
potato, 1 tablespoonful of butter, 1 tablespoonful of flour, 
i teaspoonful of salt, yelk of 1 egg. 

Method .—Flake fish fine, removing all bones and skin; 
add potato, butter, salt, beaten yelk; mix well; make into 


460 


INVALID COOKERY 


balls; roll in flour; brown in oven. Serve on hot plate. 
Garnish with parsley. 

CREAMED COLD FISH 

Ingredients: 1 cupful of flaked fish, 1 cupful of white 
sauce, 1 slice of toast, 1 slice of lemon. 

Method .—Flake fish, removing bones and skin; add 
white sauce; heat, and pour over toast on a hot dish. 
Garnish with parsley and lemon. 

SCALLOPED OYSTERS 

Ingredients: 1 cupful of oysters, 1 cupful of cracker- 
crumbs, \ cupful of milk, \ cupful of oyster juice, 2 table¬ 
spoonfuls of butter, 4 teaspoonful of pepper, 1 teaspoonful 
of salt, yelk of 1 egg. 

Method .—Drain and wash oysters; heat milk and oyster 
juice; moisten crumbs with heated mixture; spread a 
layer in buttered baking dish, then a layer of oysters; 
add salt, pepper, and bits of butter; then another layer of 
crumbs, continuing the process, having the last layer of 
crumbs;beat yelk of egg; add milk (1 tablespoonful); pour 
over top of pan; add bits of butter, and bake, covered, 
until well risen or about fifteen to twenty minutes; 
remove cover and brown. Serve in dish in which it is 
baked. 

FRIED CHICKEN 

Method. —Clean, wash, and joint chicken; wipe dry, rub 
well with salt; roll in flour; place in buttered pan; cook, 
covered, from ten to fifteen minutes or until tender; remove 
cover and brown; remove from pan; keep hot while you 
make gravy by rubbing 1 tablespoonful of flour in fat in 
pan until smooth; add 1 cupful of milk; stir until it thick¬ 
ens; pour over chicken. Serve on hot dish. 


MEATS AND FISH 


461 


HAMBURG STEAK 

Ingredients: £ pound of Hamburg steak, £ cupful of 
bread-crumbs, £ teaspoonful of salt, \ teaspoonful of onion 
juice, £ teaspoonful of parsley (minced), £ cupful of stock. 

Method. Mix all the ingredients well together; make 
into balls, and pan-broil. Serve on hot plate; garnish with 
parsley. 

BROILED HALIBUT 

Ingredients: 1 slice of halibut, 1 slice of lemon, £ tea¬ 
spoonful of butter. 

Method. —Wipe fish with damp cloth; rub well with 
salt and butter; place in buttered broiler; broil rather 
slowly, so as not to burn, for about ten minutes; place on 
hot plate and remove skin, add salt and bits of butter; 
garnish with parsley and lemon, or pour drawn-butter 
over fish, and serve at once, very hot. 

BROILED SHAD 

Method. —Split fish down back; remove large bone; 
rub with salt and olive oil or butter; broil as above, over 
moderate fire, for about twenty minutes. Serve on a hot 
plate. Garnish with a slice of lemon. Any large fish 
may be broiled in this way or may be larded with salt 
pork, and broiled in an oven. 

CODFISH BALLS AND PARSLEY SAUCE 

Ingredients: £ cupful of shredded codfish, 1 tablespoon¬ 
ful of bread-crumbs, yelk of 1 egg. 

Method. —Soak codfish for one-half hour in cold water; 
drain; add bread-crumbs and beaten egg; make into balls; 
place in buttered pan on rack of oven until golden brown. 
Serve on hot plate. Pour parsley sauce over all. 

PARSLEY SAUCE 

Ingredients: 1 cupful of stock, 1 tablespoonful of butter, 

1 tablespoonful of browned flour, £ teaspoonful of salt, 1 
teaspoonful of minced parsley. 


462 


INVALID COOKERY 


Method .—Cream butter and flour; heat stock; add to 
cream mixture; add salt and parsley; cook until it 
thickens. 

CLAMS 

Method —Clams are usually served during the season 
when oysters are forbidden. Most of the directions for 
cooking oysters may be also used for clams. If desired 
to cook in a chafing-dish, the following is a good rule. 
Wash thoroughly one dozen large clams and plunge for a 
moment into boiling water. Drain off the water, open 
them, and use only the round plump part. Have ready 
in the chafing-dish 2 teaspoonfuls of butter, and when 
quite hot dust lightly with flour, salt, and pepper if desired. 
Drop the clams in and simmer for about four minutes. 
Pour over them 1 gill of light sherry, cover, and simmer 
slowly for five minutes. Serve on hot toast. Cream 
may be used instead of the sherry. 

frog's legs 

As a rule, the green marsh frogs furnish the best hams. 
Use only the hams. Pare off the feet and truss them by 
inserting the stump along the skin of the other leg. Wash 
and soak for one hour in water to which lemon juice, salt, 
and pepper have been added. Drain, roll in flour, then 
in beaten egg, and, lastly, in fine bread-crumbs. Fry in 
hot fat till they are a light brown and serve with fried 
parsley. 


VEGETABLES 


463 


CHAPTER LII 
VEGETABLES 
Lesson 7 

Vegetable foods are less easily digested and assimilated 
than animal foods. This is due to the fact that much of 
the nutritive material of vegetable foods is enclosed in 
cells with woody covering, which resist the action of the 
digestive juice and irritate the intestinal linings. 

Beans are rich in nutriment, but are more easily digested 
jvhen combined with other materials. They should be 
sparingly served to invalids. 

The objects to be aimed at in cooking legumes are: 
to soften and separate the cell-fiber, so that the nutriment 
in close connection with it is freed. 

To cook proteid matter so as to make it digestible and 
palatable. 

To swell and burst the starch grains. 

To combine with various other material and flavoring 
materials, so that the result is a palatable dish. 

For invalids many vegetables are best served in the 
form of purges. 

In cases where water has been condemned for drinking 
purposes, care should be taken that all fresh vegetables 
that are to be eaten uncooked are washed in water that 
has been boiled. 


MASHED POTATOES 

Method .—Boil till soft and drain. When dry, mash 
fine; add 1 tablespoonful of butter, \ cupful of cream, 
i teaspoonful of salt, J teaspoonful of pepper for each 
pint of potatoes; beat until light and creamy; pile lightly 
in hot dish. Serve at once. 

Riced potatoes are made by pressing mashed potatoes 
through a ricer. Serve on hot dish, pyramid shape. 


464 


INVALID COOKERY 


SCALLOPED POTATOES 

Ingredients: 1 cupful of sliced raw potatoes, 1 cupful of 
milk, 1 tablespoonful of butter, 2 tablespoonfuls of flour, 

1 teaspoonful of salt, i teaspoonful of pepper. 

Method .—Place thinly sliced potatoes in well-buttered 
baking dish; sprinkle flour, salt, and butter over them; 
then another layer of potatoes. When full, pour milk 
over and bake, covered, until potatoes are tender (about 
one hour); remove cover, brown. Serve, garnished with 
cress. 

POTATO ROSES 

Ingredients: 1 cupful of mashed potatoes, 1 tablespoon¬ 
ful of butter, 1 egg. 

Method .—Add butter and well-beaten egg to potatoes; 
press through pastry tube on buttered paper in shape of 
roses; bring to a golden brown in oven. Serve on hot 
plate, garnished with rings of red carrot and parsley. 

POTATO SOUFFLE 

Ingredients: 1 cupful of hot mashed potatoes, 2 table¬ 
spoonfuls of cream, 1 tablespoonful of butter, 1 egg. 

Method .—Add well-beaten yelk of egg and cream to the 
potatoes; mix well; fold in stiffly beaten white; pile a 
mound lightly on buttered plate; place bits of butter over 
it; bake, covered, until well risen; remove cover and 
brown. Serve at once. 

BAKED POTATOES (WHITE OR SWEET) 

Method .—Select potatoes of uniform size; wash; clean; 
cut a small piece from the end, and bake in hot oven, keep¬ 
ing heat even, until tender (about one hour); pierce with 
hatpin to let gas escape. Serve at once, wrapped in a 
napkin, or remove one end and scoop out potato. Mash; 
add 1 teaspoonful of butter and cream, as in mashed 
potatoes. Return 'to shell and place in oven to brown, 
when you have potato surprise. Serve on hot plate. 
Garnish with parsley. Do not let baked potatoes stand, 
serve as soon as done. 


VEGETABLES 


465 


BAKED HUBBARD SQUASH 

Ingredients: ^ hubbard squash, 1 tablespoonful of 
butter, 1 tablespoonful of cream, J teaspoonful of salt, a 
dash of pepper. 

Method. Wash squash; remove seeds; bake in a moder¬ 
ate oven until tender (about one-half hour); remove skin 
formed, scoop out pulp and mash fine; add butter, cream, 
and salt; beat lightly. Serve on hot dish, or it may be 
cut in strips and baked and served without removing from 
shell. 


STEWED PEAS 

Ingredients: 1 pint of fresh or 1 can of canned peas, 
i teaspoonful of sugar and salt, 1 teaspoonful of butter,' 
a dash of pepper. 

Method. Shell; pick over peas; wash and cook in boil¬ 
ing water until tender (about one-half hour); add sugar, 
salt, pepper, butter, or drain water and add £ cupful of 
milk, and the butter, sugar, salt, and pepper; heat to a 
boil and serve hot. If canned peas are used, drain all 
juice, and heat as directed. 


CREAMED CARROTS 

Ingredients: 1 small bunch of carrots, 1 cupful of white 
sauce. 

Method. —Select young, smooth carrots; wash; scrape; 
cut in cubes; cook in boiling salt water until tender 
(about one hour); drain; chop fine; add white sauce; bring 
to a boil. Serve hot. 

CREAMED CELERY 

Ingredients: 3 or 4 stalks of celery, 1 cupful of white 
sauce. 

Method. —Clean and cut celery into 1-inch pieces; cook 
until tender; drain; add white sauce; bring to a boil. Serve 
hot over toast. 

30 


466 


INVALID COOKERY 


STRING BEANS 

Ingredients: \ pint of beans, 1 cupful of white sauce. 

Method .—String the beans, breaking in short lengths; 
wash; cook in boiling water until tender (about one-half 
hour); drain; add white sauce; heat. Serve hot. 

CREAMED ASPARAGUS 

Ingredients: 1 small bunch of asparagus, 1 cupful of 
white sauce, ^ teaspoonful of salt. 

Method .—Soak asparagus in salt water for one-half 
hour; drain; cut in 1-inch lengths; cook in boiling salt 
water until tender (about one-half hour). The tips are 
more tender than the rest; watch, and remove before boil¬ 
ing to pieces; when tender, drain; add white sauce; bring 
to a boil. Serve, laying tips on top, or they may be served 
plain by adding 1 teaspoonful of butter; add salt and hot 
water after draining. 

BAKED TOMATOES 

Ingredients: Medium-sized tomatoes, bread-crumbs, salt, 
onion juice. 

Method —Wash tomatoes; remove some of the pulp; 
add pulp to other ingredients; mix well; fill cavity made 
in tomatoes with mixture; place in baking pan; add a 
little water; bake until tender (about one-half hour). 
Serve on hot dish with sauce remaining in pan. 

SCALLOPED TOMATOES 

Ingredients: 2 or 3 fresh tomatoes or 1 cupful of canned 
tomatoes, ^ cupful of bread-crumbs, 1 tablespoonful of 
butter, l teaspoonful of salt, a dash of pepper, \ cupful 
of stock or milk. 

Method .—If fresh, wash, pare, and slice tomatoes, plac¬ 
ing in layers in baking pan; season with salt, pepper, 
butter, then a layer of bread-crumbs, having the top layer 
of crumbs; place bits of butter over the top; pour stock 


VEGETABLES 


467 


over and bake, covered, about twenty minute*; remove 
cover, and try if tomato is tender. Brown, and serve hot 
garnished with cress. 


STEWED TOMATOES 

Ingredients: 1 cupful of tomatoes, % tablespoonful of 
butter, \ teaspoonful of salt, a dash of pepper, 1 table- 
spoonful of bread-crumbs. 

Method .—Place ingredients in stew-pan, bring to a boil; 
cook about five minutes. Serve hot over toast in hot 
dish. 

STEWED CORN 

Ingredients: 1 cupful of corn, J cupful of white sauce, 
i teaspoonful of sugar, 1 tablespoonful of egg. 

Method. Mix all ingredients except egg; cook until 
tender, (about fifteen minutes); remove from fire, add 
egg. well beaten. Serve hot, or place after mixing in a 
baking dish. Sprinkle bread-crumbs over top and bake 
for twenty minutes in a moderate oven. Serve in dish 
in which it is baked. 


LIMA BEANS 

Ingredients: \ cupful of lima beans, 1 tablespoonful of 
cream, 1 teaspoonful of butter, \ teaspoonful of salt, i tea¬ 
spoonful of soda. 

Method .—If dried, soak lima beans over night in cold 
water, drain in morning; cook in boiling salt water for 
five minutes; add soda; bring to boil; drain; rinse; add 
hot water and cook until tender; drain; add cream, but¬ 
ter, salt, and bring to a boil. Serve hot. 

STUFFED SQUASH 

Ingredients: 1 small summer squash, 2 slices of stale 
bread, 1 tablespoonful of butter, 1 hard-boiled egg, 1 table¬ 
spoonful of nut meats, J teaspoonful of onion juice, \ tea¬ 
spoonful of salt, a dash of pepper, 1 uncooked yelk of egg. 


468 


INVALID COOKERY 


Method. —Wash and boil squash for fifteen minutes; 
remove; cut off top; take out seeds, and fill with force 
meat. 

Method for Force Meat. —Cut bread in dice and brown; 
melt butter in pan; add browned bread and cool; add 
minced hard-boiled egg, onion juice, salt, and minced nut 
meats; mix well; add well-beaten yelk; fill cavity in squash; 
replace cover; bake until tender (about one-half hour). 
Serve whole on hot plate. 

POTATO PYRAMID 

Ingredients: 1 cupful of hot mashed potatoes, \ cupful 
of milk, 1 egg, 1 tablespoonful of cracker-crumbs, 1 
tablespoonful of butter, \ teaspoonful of salt, a dash of 
pepper. 

Method. —Add milk, butter, salt, and pepper to well- 
mashed potatoes; beat until light; add well-beaten yelk; 
mix well; fold in stiffly beaten white; pile in pyramid 
shape on well-buttered plate; make depressions in sides 
with point of knife; rub over with white of egg; sprinkle 
with cracker-crumbs; brown in oven. Serve hot, gar¬ 
nished with parsley. 

PARSNIPS 

Ingredients: 2 or 3 small parsnips, 1 tablespoonful of 
butter, 1 teaspoonful of sugar, £ teaspoonful of salt. 

Method. —Wash and scrape parsnips; cut in strips about 
3 inches long, 1 inch thick; cook in boiling salt water 
until tender (about three-quarters of an hour); drain; 
place in buttered baking pan; sprinkle with butter, sugar, 
salt; add a little water; brown in oven. Serve very hot. 

CREAMED CAULIFLOWER 

Ingredients: 1 small cauliflower, 1 cupful of white 
sauce. 

Method. —Break cauliflower in small pieces, being 
careful not to break the flower; let stand covered with 
salted water for one-half hour; drain; cook in boiling salt 


VEGETABLES 469 

water until tender (about one-half hour); drain; add white 
sauce; bring to a boil. Serve in hot dish. 

RICE CROQUETTES 

Ingredients: \ cupful of rice, 1 pint of milk, 1 tablespoon¬ 
ful of chopped parsley, yelks of 2 eggs, salt, and pepper. 

Method .—Wash the rice and cook in a double cooker 
till thoroughly soft; add the milk when the rice is about 
half-cooked; when cooked, take from the fire and beat 
till smooth, mashing all the grains; then add the well- 
beaten yelks of the eggs, the parsley, and seasoning, 
and cook ten minutes longer. Use white pepper if 
possible. Pour it out on a platter to cool, then form in 
pretty rolls, about 3 inches in length. Roll these in 
beaten eggs, then in bread-crumbs, and fry in boiling 
lard. Drain and serve with any meat cooked with 
gravy. May be served as a supper dish without meat. 

BOILED RICE 

Ingredients: 2 tablespoonfuls of rice, 1 pint of boiling 
water, \ teaspoonful of salt. 

Method .—Wash the rice and put into a double cooker 
with the boiling water; cook until the grains are quite 
soft; add as much water as needed to keep from sticking 
to the vessel while cooking; avoid stirring as much as 
possible; turn into a colander to drain, and then dry 
off for a few minutes in the oven. This may be eaten as 
a breakfast food or as a vegetable with any kind of 
meat which is cooked with a gravy. It combines well 
with any stewed meat. Rice may also be steamed over 
boiling water till quite soft, and served in the same way. 
The kernels, if possible, should be kept whole. 


470 


INVALID COOKERY 


CHAPTER LIII 
FRUITS AND DESSERTS 

Lesson 8 

The uses of fruits as food have been summed up as 
follows: 

To furnish nutriment. 

To convey water into the system, and relieve thirst. 

To introduce various salts and organic acids, which 
improve the quality of the blood and react favorably 
upon the secretion. 

As antiscorbutics. 

As diuretics, and to lessen the acidity of the urine. 

As laxatives. 

To stimulate the appetite, improve digestion, and 
give variety to the diet. 

The banana, date, fig, prune, and grape contain the 
most nutriment, which is largely in the form of sugar. 

Fruits containing the most water are melons, oranges, 
lemons, limes, and grapes. 

The best fruits for laxative purposes are apples, figs, 
prunes, peaches, and berries. 

Dyspeptics should be cautioned against eating all 
hard-skinned or coarse-fibered fruits. 

The substances chiefly used as desserts for invalids 
are milk, eggs, gelatin; the cereals, starchy foods, such 
as sago, tapioca, arrowroot, fruits, and fruit ices. 

Milk taken in the form of junket or milk jelly, which 
is milk partly digested, may be served with a variety of 
flavors, and is one of the most valuable desserts for 
invalids. 

Milk that has been boiled, sterilized, condensed, or 
evaporated should not be used for junkets. 

Particular care should be taken to cook starchy foods 
thoroughly. 

The time element in the preparation of desserts and 


FRUITS AND DESSERTS 


471 


all foods should be carefully considered, so that the food 
may reach the patient in the best possible condition. 

Always use the daintiest dishes procurable for serving. 

LEMON ICE 

Ingredients: £ cupful of sugar, 1 cupful of water, { 
cupful of lemon juice. 

Method— Make a syrup of the sugar and water, boiling 
about five minutes. Skim if necessary; cool; add lemon 
juice, strain, and freeze. 

Orange ice is made by using oranges in place of the 
lemons, or any fruit juice may be used. Sherbet is 
made by adding the beaten white of egg or 1 teaspoonful 
of dissolved gelatin when half frozen. If only softly 
frozen it is called frappS; punch, if fruit is added. 

PHILADELPHIA ICE-CREAM 

Ingredients: 1 cupful of cream, 2 tablespoonfuls of 
sugar, J teaspoonful of vanilla extract or one-quarter of 
a vanilla bean. 

Method .—Place half of the cream in a double boiler; 
add sugar and vanilla; cook until sugar is dissolved, 
stirring constantly; strain and cool; add the rest of 
cream and freeze. Any flavoring may be used. If the 
fruit cream is desired, use the same amount of fruit as 
cream, and proceed as above. 

FROZEN CUSTARD 

Ingredients: 1 cupful of milk, 1 tablespoonful of sugar, 
yelks of 2 eggs, J teaspoonful of vanilla, a pinch of salt, 

1 teaspoonful of cornstarch. 

Method .—Place milk in double boiler; add sugar and 
cornstarch, well mixed; stir until it begins to thicken; 
remove from fire; add flavoring and well-beaten egg; 
stir until mixed; strain, cool, and freeze. These two 
rules are the foundation for all ice-cream. Add fruit 
and it is called tutti frutti; nuts, and it is called pistachio. 


472 


INVALID COOKERY 


Coffee may be used in place of half of the milk. Different 
flavors give the name to the cream. 

CHARLOTTE RUSSE 

Ingredients: 1 cupful of cream, 1 tablespoonful of sugar, 

\ teaspoonful of vanilla, £ dozen lady fingers, 1 table¬ 
spoonful of granulated gelatin, white of 1 egg, £ cupful 

of water. . 

Method .—Dissolve gelatin in water; whip cream alter 
adding sugar and flavoring; when stiff, add stiffly beaten 
white of egg and gelatin, and beat well; line with lady 
fingers; pour mixture in center; set in cold place. 

BAVARIAN CREAM 

Ingredients: 1 tablespoonful of grated chocolate, 1 
cupful of milk, 1 tablespoonful of sugar, 1 tablespoonful 
of granulated gelatin, 2 tablespoonfuls of cold water, 
£ pint of whipped cream, £ teaspoonful of vanilla. 

Method .—Dissolve chocolate; place milk in double 
boiler; add chocolate and sugar; heat to boiling-point; 
remove from fire; add extract; pour over dissolved gelatin; 
set in cold place until it hardens; then fold in whipped 
cream; pour in mold; set in cold place until firm.. Serve 
very cold. Any fruit juice desired may be used in place 
of chocolate. 

A pretty way to serve ice-cream is to bake angel cake 
in cups. When cold, remove the inside; make handles of 
spaghetti, softened in hot water, formed in loops, and dried; 
stick in sides of cake, making a basket; fill with cream; 
place a candied cherry on top. Serve on cold plate. 
Garnish with rose leaves and buds. 

STRAWBERRY BLANC MANGE 

Ingredients: 1 cupful of milk, 1 teaspoonful of corn¬ 
starch, 1 tablespoonful of sugar, \ teaspoonful of flavoring, 
1 egg, 1 cupful of berries (fresh are best). 

Method. —Heat milk in double boiler; add cornstarch 
and sugar, well mixed; stir until it thickens; remove 


FRUITS AND DESSERTS 


473 


from fire; add well-beaten egg and flavoring, stirring 
until well mixed; pour in border molds; set in cold 
place until firm; turn out on cold plate; fill center with 
the well-washed berries. Serve cold with whipped cream 
or boiled custard. Flavoring with chocolate or filling the 
center with bananas make agreeable changes. 

ORANGE PUDDING 

Slice a sweet orange thin after peeling; remove seeds; 
cover with sugar. Pour boiled custard over orange; 
make a meringue; place over all; set in oven until firm 
(about two minutes). Serve cold. 

Do not let the orange heat, as it will become bitter. 

LEMON JELLY AND SNOW PUDDING 

Ingredients: 2 tablespoonfuls of granulated gelatin, 
2 tablespoonfuls of cold water, 1 tablespoonful of sugar, 
1 tablespoonful of lemon juice, 1 cupful of hot water. 

Method .—Soak gelatin in cold water five minutes; 
add boiling water, stirring all the time; add sugar and 
lemon juice; pour in mold; set in cold place until firm. 
By adding the stiffly beaten white of an egg just as it 
begins to harden, beating until stiff and white, it makes 
what is called snow pudding. Put on ice. Serve on cold 
dishes with whipped cream or custard. 

TAPIOCA CREAM 

Ingredients: 1 teaspoonful of pearl tapioca, 1 cupful 
of milk, 1 tablespoonful of sugar, 1 egg, j teaspoonful of 
salt, J teaspoonful of flavoring. 

Method .—Wash and soak tapioca in cold water over 
night; drain; place in double boiler; add milk, sugar, and 
salt; cook until it thickens; remove from fire; add flavor¬ 
ing and well-beaten egg yelk; turn into serving dish; 
cover with a meringue made of the stiffly beaten white; 
place in oven until golden brown. May be served either 
cold or hot. A few chopped dates may be added when 
desired. 


474 


INVALID COOKERY 


BANANA CREAM 

Ingredients: 1 banana, i cupful of cream, 1 teaspoonful 
of sugar, 1 teaspoonful of gelatin, a few drops of vanilla. 

Method. —Peel and mash banana; dissolve gelatin in 
cold water; add mashed banana, sugar, cream, and 
vanilla; mix.well; add dissolved gelatin; turn into mold; 
set in cold place until firm. Serve cold with sponge cake. 

COTTAGE PUDDING 

Ingredients: \ cupful of sugar, J cupful of milk, J 
cupful of butter, 1J cupfuls of flour, 1 egg, 1 teaspoonful 
of baking powder, \ teaspoonful of flavoring or £ tea¬ 
spoonful of grated nutmeg. 

Method. —Cream sugar and butter; add well-beaten 
egg and milk, then flavoring and flour, with baking 
powder sifted together; place in buttered pan; bake in 
moderate oven about one-half hour or until done; cut 
in squares. Serve with lemon sauce. 

APPLE TAPIOCA 

Ingredients: 1 tart apple, 1 tablespoonful of sugar, 
1 cupful of water, 1 tablespoonful of pearl tapioca, salt, 
nutmeg or cinnamon. 

Method. —Soak tapioca for three hours in cold water; 
pare and core apple; place in pudding pan; fill cavity 
with sugar; add tapioca; add salt and water; grate nutmeg 
over; bake about one hour or until apple is tender and 
tapioca clear. Serve either hot or cold, with cream 
and sugar. 


CREAMED RICE WITH STRAWBERRIES 

Ingredients: 1 tablespoonful of rice, 1 cupful of milk, 
1 cupful of berries, 2 tablespoonfuls of sugar, 1 cupful 
of whipped cream, 1 teaspoonful of gelatin. 

Method. —Wash rice; place in double boiler; add milk; 
eook until tender; add sugar; soak gelatin in cold water 
ten minutes, and add to rice, stirring until well mixed. 


FRUITS AND DESSERTS 


475 


When cold, fold in whipped cream; pour in border mold; 
set in cold place until firm; turn out on cold plate; fill 
center with well-washed and hulled berries, saving some 
of the best with their caps to garnish the plate. 

GELATIN FRUIT PUDDING 

To a plain lemon jelly, when beginning to set, add 
sliced fruit, as oranges, pineapples, peaches, bananas, 
white grapes, strawberries. Or the fruit may be placed 
in layers and the gelatin poured over and left to set, and 
then another layer of fruit added. Set in cold place 
until firm. Serve cold with cream or soft custard. 

SPANISH CREAM 

Ingredients: 1 tablespoonful of granulated gelatin, 
2 tablespoonfuls of cold water, 1 cupful of milk, 2 table¬ 
spoonfuls of sugar, J teaspoonful of vanilla, 2 eggs, 
| teaspoonful of soda. 

Method .—Soak gelatin five minutes in cold water; 
heat the milk; add soda, sugar, and beaten yelks; stir 
until it thickens; pour over gelatin; stir until cold; add 
stiffly beaten whites and vanilla; pour over sliced fruit, 
as bananas, oranges, fresh berries; set in cold place until 
firm. Serve cold with whipped cream or boiled custard. 

RICE PUDDING 

Ingredients: £ cupful of rice, 1 tablespoonful of sugar, 

1 pint of milk, \ teaspoonful of flavoring. 

Method .—Wash rice; add sugar, salt, milk, and flavor¬ 
ing; bake, covered, until it thickens and rice is tender 
(about one hour); stir often. A few raisins may be 
added. Serve either hot or cold with cream and sugar. 

FRENCH BREAD PUDDING 

Ingredients: £ cupful of bread-crumbs, 1 cupful of 
milk, 1 tablespoonful of sugar, J teaspoonful of salt, 
i teaspoonful of soda, 1 egg, J teaspoonful of nutmeg. 


476 


INVALID COOKERY 


Method .—Mix bread-crumbs, sugar, salt; add milk 
m which soda has been dissolved; add well-beaten egg 
and nutmeg; place in baking pan, bake, covered, about 
one-half hour or until firm. Serve hot with lemon sauce 
or cream and sugar. 


GRAHAM PUDDING 

Ingredients: £ cupful of molasses, £ cupful of butter, 
£ cupful of sour milk, £ cupful of chopped raisins, 2 
cupfuls of Graham flour, £ teaspoonful of soda, £ tea¬ 
spoonful each of cinnamon, cloves, and nutmeg, 1 egg. 

Method .—Dissolve soda in molasses; add milk, butter, 
spices, beaten egg; mix well; wash and stone raisins; 
mince; cover with flour; add to mixture with flour; place 
in well-buttered pudding pan, and steam three hours. 
Serve hot with lemon juice. 

RICE AND APPLE SOUFFLE 

Ingredients: 1 tablespoonful of rice, 1 cupful of milk, 
1 tart apple, 1 egg, 1 tablespoonful of sugar. 

Method .—Wash rice; cook in double boiler until tender; 
add well-beaten yelk and sugar; place in border mold; 
pare and core apple; cook until tender. When rice is 
firm, turn on cold plate, place apple in center, and fill 
core cavity with jelly; cover all with stiffly beaten whites; 
place in oven until a golden brown. Serve with cream 
and sugar. 

ARROWROOT BLANC MANGE 

Ingredients: 1 cupful of milk, 2 tabiespoonfuls of 
arrowroot, 2 teaspoonfuls of sugar, £ teaspoonful of 
vanilla, 1 pinch of salt. 

Method .—Place milk in double boiler; heat; add arrow- 
root and sugar mixed to a paste with cold water; stir 
until it thickens; remove from fire; add salt and flavoring; 
pour in mold; set in cold place until firm. Serve cold 
with whipped cream. Garnish with candied cherries. 
Lady fingers may be served with it. 





Bouillon and arrowroot blanc mange. 


Strawberries and a cream puff . 


Calf’s foot jelly and other things. 














478 


INVALID COOKERY 


FLOATING ISLAND 

Ingredients: 1 cupful of milk, 1 tablespoonful of sugar, 
j teaspoonful of flavoring, a dash of salt, 1 teaspoonful 
of powdered sugar, 1 egg, \ teaspoonful of cornstarch. 

Method for the Custard.— Heat the milk in double 
boiler; add sugar and salt; take from fire; add well-beaten 
egg yelk; stir until it thickens; add flavoring; turn into 
a glass dish and set in cold place. 

Method for the Island. —Beat white of egg till very 
stiff; add powdered sugar; drop isLands (about \ tea¬ 
spoonful) on buttered paper; place in oven for a minute; 
then place on top of custard. 

FRUIT SOUFFLE. 

Ingredients: 1 cupful of stewed fruit, ^ cupful of sugar, 
white of 1 egg, \ teaspoonful of flavoring. 

Method. —Cook fruit until very tender; strain through 
coarse strainer; add sugar and flavoring; cool; then fold 
in stiffly beaten white; set in cold place, serve cold. 
Any fruit may be used, either dried or fresh apples, 
peaches, prunes, apricots, berries. 

IMPERIAL CREAM 

Make a plain lemon jelly; divide in thirds; color one- 
third pink and turn into square mold; mold the plain 
lemon jelly in a square mold; make a snow pudding of 
the other third. When nearly ready to harden, drop 
lemon and pink jelly, cut in inch cubes, into snow pudding; 
place in mold; set in cold place. Serve on cold dish. 
Garnish with macaroons. Pour boiled custard over, and 
serve. 

PRUNE SPONGE 

Ingredients: Juice of 1 lemon, i cupful of sugar, 2 eggs, 
1 tablespoonful of gelatin, 1 cupful of water, 1 cupful of 
jellied prunes. 

Method. —Heat juice of lemon; add sugar; stir until 


FRUITS AND DESSERTS 


479, 


dissolved; add well-beaten yelks; stir until thick; pour 
over dissolved gelatin; fold in stiffly beaten whites; pour 
into border molds; set in cold place until firm; turn 
on cold dish; fill center with jellied prunes. Serve with 
whipped cream. 

JELLIED PRUNES 

Ingredients: J cupful of dried prunes, J cupful of sugar 
1 cupful of water. 

Method. Wash prunes very thoroughly; soak over 
night; cook on back of stove where they will not boil 
until tender; remove stones and drop into hot syrup; bring 
to a boil; set aside until wanted. Use as directed above. 

PRUNE WHIP 

Ingredients: 1 cupful of cooked prunes, white of 1 egg, 

1 tablespoonful of sugar, 1 tablespoonful of lemon juice! 

Method. Strain prunes through coarse sieve, removing 
stones; add lemon juice; fold in stiffly beaten white; add 
sugar, pile on buttered plate; stand in oven for about 
one minute or until set. Serve cold with whipped 
cream or thin boiled custard. 

CRACKER PUDDING 

Ingredients: 2 soda crackers, 1 cupful of milk, 2 table¬ 
spoonfuls of sugar, a dash of salt, J teaspoonful of flavor¬ 
ing; 1 egg, 1 tablespoonful of butter. 

Method .—Roll crackers; add milk, sugar, salt, beaten 
yelk, flavoring, and butter; mix well; place in buttered 
pudding dish; bake about fifteen minutes, or until when 
a knife is run in it is clear on removing; place a meringue 
on top; set in oven until a golden brown. Serve hot 
with currant jelly on top. 

GRAPE FLUFF 

Ingredients: 1 tablespoonful of granulated gelatin, 
i cupful of cold water, \ cupful of sugar, 1 cupful of 
grape juice, juice of 1 lemon, whites of 3 eggs. 


480 


INVALID COOKERY 


Method .—Soak gelatin in cold water five minutes; 
dissolve by standing over steam; add sugar to grape 
juice; stir until dissolved; add gelatin and lemon juice; 
mix well; stand in cold place until it begins to thicken, 
then add stiffly beaten whites; beat until light and 
stiff. Serve cold with whipped cream. 


RHUBARB BLANC MANGE 

Ingredients: 1 cupful of strained rhubarb juice, J 
teaspoonful of vanilla, 1 teaspoonful of lemon juice, 

J cupful of sugar, 2 tablespoonfuls of cornstarch, | 
teaspoonful of soda. 

Method .—Wash and stew rhubarb without peeling; 
strain; measure juice; add soda, then sugar; return to 
fire; add cornstarch made into a paste with cold water; 
cook until clear and thick; remove from fire; add flavoring; 
pour in mold; set in cold place until firm. Serve with 
cream and sugar. 

APPLE CHARLOTTE 

Ingredients: 1 cupful of bread-crumbs, | cupful of 
sliced apples (tart), 2 tablespoonfuls of sugar, 2 table¬ 
spoonfuls of butter, 1 teaspoonful of cinnamon or nutmeg, 
a little salt, hot water or milk. 

Method .—Moisten bread-crumbs; place a layer in 
buttered pudding pan; then a layer of apples; sprinkle 
with sugar and spice; add bits of butter; continue until 
pan is full, having the top layer of crumbs; pour milk or 
water over until covered, bake (covered) about one hour 
or until apples are tender. Remove cover and brown. 
Serve hot with hard sauce or cream and sugar. 

BAKED BANANA 

Peel and cut banana in half; place in a shallow pan; 
sprinkle with sugar, a little lemon juice, and water; bake 
under cover until soft and light brown (about twenty 
minutes). 


FRUITS AND DESSERTS 


481 


date bonbons 

Wash dates; remove seeds; fill cavity with chopped 
salted almonds or peanuts; close cavity; roll in powdered 
sugar. 

GRAPEFRUIT 

Cut in half, crosswise; separate pulp from skin, then 
make cuts separating pulp from tough portion; remove 
tough part; sprinkle with sugar; let stand in cold place 
ten minutes. Serve, garnished with a few candied 
cherries. 

BANANA CUSTARD 

Make a rich, soft custard with yelk of egg, milk, and 
cornstarch, using any flavoring desired; peel a banana, 
cut in thin slices, and line the bottom and sides of the 
glass dish in which the custard is to be served; beat the 
white of the egg to a stiff froth; drop in molds on top of 
the custard; put in oven for a moment to set the white, 
and serve cold. If desired, the bananas may be moistened 
with lemon juice. 

RICE CREAM 

Ingredients: 1 pint of rich milk (or thin cream if 
obtainable), 1 egg, 2 tablespoonfuls of sugar, £ ounce of 
gelatin, J cupful of cold, boiled rice. 

Method .—Out of the milk, egg, and sugar make a smooth 
custard; dissolve the gelatin in cold water and add to the 
custard, then stir in the boiled rice; flavor with vanilla; 
turn into a jelly mold until it is set. Serve with whipped 
cream. 

apple SNOW 

Put a cupful of fresh apple-sauce through a colander 
to remove any stringy portions; sweeten and flavor to 
taste; whip i cupful of sweet cream and the white of an 
egg separately, then together, and add the apple; pour 
into mold, and set on ice until needed. 

31 


482 


INVALID COOKERY 


CHAPTER LIV 
SALADS 
Lesson 9 

A salad is composed of two parts—the body and the 

dressing. „ „ ... , . 

Salads may be used as a means of furnishing nutri¬ 
ment, to stimulate the appetite, improve digestion, and 
give variety to the diet. 

Salads may be a combination of fish, meat, chicken, 
with appropriate vegetables, or may be made wholly 
from vegetables, or may be a combination of fruits with 

gelatin. . . 

All materials used in salads should be in first class 

condition. . 

With the exception of onions and parsley, ingredients 
for salads should be cut, never chopped; everything 
should be thoroughly cold before mixing. 

A salad of fish, vegetables, or chicken may appro¬ 
priately take the place of meat at dinner in hot weather. 

Bean salad is one of the most nutritious of the vege¬ 
table salads. , 

Fruit salads should be served thoroughly chilled. 
They are used as a delicacy to give variety at the beginning 
of the meal, or may be used as a dessert. 

The tempting quality of any salad, and especially of 
fruit salads, is much enhanced by the way it is served. 

Use small, dainty dishes, sherbet cups, or small fruit 
cups. Set the fruit cups on a plate surrounded by rose 
leaves, or green leaves and buds. . # . 

A dainty vegetable or meat salad, with the addition 
of crisp small crackers, makes a tempting luncheon for 

convalescents. . . 

In making salads toss the ingredients with a fork 
rather than stir with a spoon. 


SALADS 


483 


RIBBON SALAD 

Ingredients: \ cupful of cold string beans, £ cupful of 
celery, £ cupful of cold peas, 2 or 3 lettuce leaves, 1 red 
radish, £ teaspoonful of onion juice, French dressing. 

Method. —Cut beans and celery in inch lengths; mix 
each separately with dressing; add onion juice to beans; 
arrange lettuce leaves on salad plate; arrange vegetables 
in layers on lettuce, having celery in the center; pour a 
spoonful of dressing on top; garnish with radish cut in 
rounds. 

WILTON SALAD 

Ingredients: 1 boiled beet, £ cupful of celery, 1 hard- 
boiled egg, French dressing. 

Method. Cut beets in fancy shape; celery in cubes; egg 
in slices; mix altogether; add dressing. Serve on salad 
plate; garnish with parsley. 

FISH SALAD 

Ingredients: £ cupful of flaked fish, £ cupful of shredded 
celery, 1 teaspoonful of minced parsley, French dressing. 

Method. —Mix each ingredient with dressing and com¬ 
bine. Serve arranged on lettuce leaves on salad plate; 
garnish with sliced lemon. 

EGG SALAD OR STUFFED EGG 

Ingredients: 1 hard-boiled egg, 1 teaspoonful of minced 
chicken, £ teaspoonful of salt, 1 teaspoonful of cream, 
a dash of pepper, Mayonnaise dressing. 

Method. —Cut egg in half lengthwise, being careful 
not to break the white; cream the yelk; add chicken, 
salt, cream, pepper; mix well; fill cavity in white with 
mixture; place on bed of parsley; pour dressing over all. 
Serve with bread and butter sandwiches. 

CHICKEN SALAD 

Ingredients: 1 cupful of minced chicken, 1 cupful of 
minced celery, Mayonnaise dressing. 


484 


INVALID COOKERY 


Method. —Mix chicken and celery; add dressing; 
arrange on lettuce leaf; one-half cupful of minced nuts 
may be added. This makes a very rich salad. 

MACEDOINE SALAD 

Ingredients: \ cupful each of peas, beets, carrots, pota¬ 
toes, string beans, celery, and asparagus, French dressing. 

Method. —Cook all but the celery till soft, then cut in 
cubes or fancy shapes; mix each with dressing; arrange 
on lettuce leaf, in layers of contrasting colors; garnish 
with celery tips. 

FRUIT SALAD 

Ingredients: 1 banana, 1 orange, 1 cupful of diced 
pineapple, 1 cupful of minced celery, 1 cupful of minced 
English walnuts, a few candied cherries, French dressing. 

Method.— Remove skin of banana carefully, making 
a boat to use to serve the salad in; halve the orange; 
remove pulp without breaking skin, making bowls for 
serving; cut banana, celery, and orange in fancy shapes; 
mix all the fruit separately with the dressing; keep cold; 
blanch and mince nuts; mix with dressing; combine, 
and fill banana boat and orange shells; arrange on salad 
plate in bed of lettuce or parsley; place cherries on top. 
Serve sponge cake or lady fingers with salad. 

BIRD-NEST SALAD 

Ingredients: 1 cupful of cottage cheese, 1 hard-boiled 
egg; French dressing. 

Method. —Mold cheese in balls the size of marbles; chop 
egg fine; add to part of cheese before molding, or color 
part of cheese with spinach juice and add to plain cheese 
before molding; arrange on the lettuce leaf; pour dressing 
over. 

POTATO SALAD 

Ingredients: 1 cupful of potatoes, % cupful of minced 
celery, 1 teaspoonful of minced parsley, i teaspoonfu) 
of onion juice, French dressing. 


SALADS 


485 


Method. Cut potatoes into fancy shapes, using them 
while hot; cut celery into cubes; mix each with dressing; 
then combine and serve on lettuce leaf; garnish with hard- 
boiled egg or red beets or radish, cut into rounds. 

BEET AND EGG SALAD 

Ingredients: 1 cupful of cooked red beets, 2 hard-boiled 
eggs, French dressing. 

Method. Cut beets in fancy shapes; slice eggs; mix 
with dressing; arrange on lettuce leaf. Serve with meats. 

WALDORF SALAD 

Ingredients: 1 cupful of raw apple, 1 cupful of celery, 
i cupful of nut meat, French dressing. 

Method. —Peel and cut an apple into dice; cut celery 
into cubes; blanch and mince nuts; mix all separately with 
the dressing; arrange on lettuce leaf, or remove top and 
pulp of apple, so as to save the skin for a cup to hold the 
mixture. Serve on salad plate; garnish with lettuce or 
parsley. 

TOMATO SALAD 

Ingredients: 1 smooth tomato, 1 teaspoonful of minced 
onion or onion juice, Mayonnaise dressing. 

Method. —Peel the tomato carefully; remove top and 
pulp; mince pulp; add minced onion and dressing; refill 
tomato case; put a spoonful of dressing over and place 
on lettuce leaf. Serve with meats. 

ASPARAGUS AND SALMON SALAD 

Ingredients: 1 cupful of flaked salmon, \ cupful of 
asparagus tips, \ cupful of celery, Mayonnaise dressing. 

Method. —Flake the salmon, removing bones and skin; 
cut asparagus and celery into inch pieces; mix each with 
dressing and combine. Serve on lettuce leaf. 


486 


INVALID COOKERY 


BEAN SALAD 

Ingredients: 1 cupful of beans, 1 tablespoonful of 
minced white onion, 1 tablespoonful of tomato sauce, 

1 tablespoonful of mustard dressing (Heinz). 

Method .—Mix ingredients well, being careful not to 
break the beans. Serve on lettuce leaf. Very good 
for luncheon. 

LEMON DRESSING 

Very nice when patient cannot have vinegar. Juice 
of 1 lemon; as much cold water; | teaspoonful of salt; 
1 teaspoonful of sugar; mix well. 

CREAM DRESSING 

Ingredients: 2 eggs, 2 tablespoonfuls of butter, 2 
tablespoonfuls of vinegar, 2 tablespoonfuls of water. 

Method .—Beat eggs slightly; place water and vinegar 
in double boiler; add butter, heat, and add eggs slowly; 
do not boil, but stir until it is thick as cream; remove 
from fire, and add salt. Be very careful not to curdle. 

BANANA SALAD 

Peel and split bananas; roll in chopped nuts and place 
on crisp lettuce leaf. Just before serving, place a spoonful 
of cream dressing over. Serve with small cakes. 

MIXED FRUIT SALAD 

Three or more kinds of fruit may be used, raw or 
canned; place fruit in layers, sprinkling each with sugar; 
pour cream dressing over; let stand to set; before serving, 
sprinkle thickly with cocoanut. Peaches, oranges, pine¬ 
apple, banana, etc., may be used. 

ORANGE SALAD 

Peel large sweet orange, and cut in thin round slices; 
place a layer in the bottom of the dish, cover with Mayon¬ 
naise dressing, and continue to alternate the layers, 


MISCELLANEOUS FOODS 


487 


finishing with the sliced oranges. This is a quickly pre¬ 
pared, simple relish when greens or other salads are not 
available. 

COTTAGE-CHEESE SALAD 

Ingredients: 1 cupful of cottage cheese, \ cupful of 
chopped celery, \ cupful of French dressing or cooked 
Mayonnaise, 1 hard-boiled egg, 4 walnuts. 

Method .—Prepare the cheese and drain thoroughly; 
arrange the cheese in the dish in which it will be served 
on lettuce leaves or cress, and alternate layers of finely 
chopped celery, the walnut meat, and a thin slice of hard- 
boiled egg. 


CHAPTER LV 

MISCELLANEOUS FOODS 

Lesson 10 

MINT SAUCE 

Ingredients: 2 tablespoonfuls of minced green mint, 
2 tablespoonfuls of sugar, \ cupful of vinegar. 

Method .—Mince mint very fine; add sugar and vinegar; 
place in wide-mouthed bottle; shake well; let stand twenty- 
four hours, then it is ready to serve after shaking. 

EGG SAUCE 

Ingredients: 2 tablespoonfuls of butter, 1 tablespoonful 
of flour, J teaspoonful of salt, £ cupful of hot water 
2 eggs, a dash of pepper. 

Method .—Blend butter, flour, salt, pepper; add water; 
boil five minutes; remove from fire; add well-beaten egg, 
stirring all the time; boil 1 egg twenty minutes; when 
cold, slice and add to sauce. Serve with fish. 



488 


INVALID COOKERY 


TOMATO SAUCE 

Ingredients: \ cupful of tomato juice, J cupful of water, 
3 whole cloves, 1 whole allspice, \ teaspoonful of mixed 
herbs, £ teaspoonful of onion juice, 1 teaspoonful of 
butter, 1 tablespoonful of flour, i teaspoonful of salt, 
a dash of pepper. 

Method .—Place tomato juice, water, and spices in sauce¬ 
pan; cook for five minutes; strain; return to fire; add 
flour and butter well blended; stir until it thickens; may 
be kept until needed. 


LEMON SAUCE 

Ingredients: 1 cupful of hot water, ^ cupful of sugar* 
1 tablespoonful of flour, 1 tablespoonful of butter, 1 
tablespoonful of lemon juice. 

Method .—Mix flour and sugar, add water slowly, 
stirring all the time; cook until it thickens; remove from 
the fire; add butter. Lemon juice or any flavoring 
desired may be used. 


HARD SAUCE 

Ingredients: 3 tablespoonfuls of butter, 6 tablespoon¬ 
fuls of sugar, i of white of 1 egg, \ tablespoonful of cream, 
nutmeg. 

Method .—Cream butter and sugar. When light and 
creamy, add unbeaten egg and the cream, a little at a 
time; heap on dish; grate nutmeg over all; put in cold 
place until needed. 

ANOTHER HARD SAUCE 

Beat l pound of butter to a cream; add gradually 
1 cupful of powdered sugar; add 4 tablespoonfuls of 
boiling water, one at a time. Beat for five minutes, 
add the white of 1 egg and 1 teaspoonful of vanilla. Put 
mixture at once into the serving dish and set in cold 
place. 


MISCELLANEOUS FOODS 


489 


BROWN SAUCE 

Ingredients: 2 tablespoonfuls of brown flour, 2 table¬ 
spoonfuls of butter, 1 cupful of stock, £ teaspoonful of 
salt, a dash of pepper. 

Method. —Brown flour by placing in hot frying pan 
and stirring until a golden brown; add butter, salt, pepper; 
mix well; add stock; stir over fire until thickened. By 
adding 1 tablespoonful of minced parsley, we have 
parsley sauce. 

LEMON SYRUP 

Ingredients: 5 lemons, 8 pounds of sugar, 3 ounces of 
citric acid, 3 quarts of water. 

Method. —Wash lemons; roll until soft; remove seeds 
and juice; add to the water and sugar; boil fifteen minutes. 
Half of the skin may be boiled with it; be sure all seeds 
are removed. Strain in a jar; add citric acid while hot; 
stir until dissolved; let stand twenty-four hours; bottle 
and keep in a cold place; 1 tablespoonful of syrup to a 
glass of water makes a delicious lemonade. 

MADE MUSTARD 

Ingredients: 2 tablespoonfuls of dry mustard, 1 table¬ 
spoonful of flour, £ cupful of vinegar, £ cupful of water, 

1 teaspoonful of sugar, £ teaspoonful of salt. 

Method. —Mix dry ingredients; heat water and vinegar; 
add slowly to dry ingredients, stirring all the time; cook 
until it thickens. 

SPONGE CAKE 

Ingredients: £ cupful of powdered sugar, £ cupful of 
flour, a dash of salt, £ teaspoonful of flavoring, 3 eggs, 

£ teaspoonful of baking powder. 

Method. —Beat yelks smooth; add to the sugar; mix 
well; add flour, baking powder, and salt, sifted together; 
beat well; add flavoring; fold in stiffly beaten whites; 
bake in a moderate oven in gem pans until a straw comes 
out clean. 


490 


INVALID COOKERY 


HOT-WATER SPONGE CAKE 

Ingredients: £ cupful of powdered sugar, £ cupful of 
flour, £ cupful of boiling water, £ teaspoonful of baking 
powder, a dash of salt, £ teaspoonful of flavoring, 2 eggs. 

Method .—Beat yelks smoothly; cream sugar well into 
yelks; add flour, baking powder, and salt, sifted together; 
beat well; add boiling water carefully, a little at a time, 
stirring all the time; add flavoring; fold in stiffly beaten 
whites; bake in well-buttered pan, in moderate oven, 
about one-half hour. 

GINGERBREAD 

Ingredients: £ cupful of brown sugar, £ cupful of 
molasses, £ cupful of sour milk, 1£ cupfuls of flour, 1 
tablespoonful of butter, 1 teaspoonful of soda, £ tea¬ 
spoonful each of cinnamon and ginger, 1 egg. 

Method .—Cream sugar and butter; dissolve soda in the 
molasses and milk; mix well; add sugar and spices, beaten 
egg and flour; mix well; bake in buttered pan in moderate 
oven about one-half hour. 

MARGUERITES 

Butter long branch crackers; beat white of egg stiff; 
add 1 tablespoonful of powdered sugar; spread on crackers; 
place blanched English walnuts on top of each other in 
half or chopped fine; place in oven until light brown; 
1 egg (white) will cover 8 or more crackers. Very nice 
to serve for lunch. 


ORANGE MINT CUPS 

Cut sour orange in half; remove pulp; add 1 table¬ 
spoonful of powdered sugar, £ teaspoonful of finely chopped 
mint, 1 teaspoonful each of lemon and cherry juice; 
chill; return to orange basket. Serve, garnished with 
mint. 

FRUIT SHORTCAKES 

Ingredients: 1 cupful of flour, 1 teaspoonful of baking 
powder, 1 teaspoonful of sugar, £ teaspoonful of salt, 


MISCELLANEOUS FOODS 


491 


1 tablespoonful of butter, J cupful of milk, 1 egg, 1 
tablespoonful of powdered sugar. 

Method .—Sift flour, baking powder, and salt together; 
cream butter and sugar; add beaten yelk; mix well; add 
milk and flour; beat thoroughly; roll \ inch thick; cut 
in squares; butter well; place one on the top of the other; 
bake in moderate oven about fifteen minutes. When 
baked, separate and butter; cover with stiff beaten white 
and sliced orange; sprinkle with sugar; place squares 
together. Serve either hot or cold. Whipped cream 
may be used in place of white of egg. Any fruit desired 
may be used. 


COOKERY ADJUNCTS 

Crumbs are used for many purposes in the kitchen. 
Stale pieces of bread may be thoroughly dried in a cool 
oven and then brought to a golden brown, being careful 
not to scorch. All dark or burnt pieces should be dis¬ 
carded before rolling. If a food chopper is available, they 
may be passed through that. These will keep for some 
time in air-tight jars. Crusts and any scraps of clean 
bread may be saved and utilized in this way to improve 
the cookery of chops, fish, croquettes, and for various 
other purposes. Fresh crumbs are needed for dressing 
for meat foods, and for this purpose bread a couple of 
days old is best. The crusts should be removed before 
crumbing. 

Browned flour is a term given to ordinary flour which 
has been spread thinly on a baking plate and slightly 
browned in a cool oven. Scorching or overbrowning 
must be guarded against. A scorched flour will render 
bitter any food in which it is used. Browned flour has 
a dark cream tint, and is used for thickening brown 
gravies, soups, and sauces. 

Caramel is made by melting sugar over a slow fire and 
allowing it to simmer till it is a dark brown. Water is 
then added to it, and the liquid is used for coloring cus¬ 
tards, sauces, gravies, soups, etc. A pound of sugar may 


492 


INVALID COOKERY 


be diluted with a pint of water. The fluid will not fer¬ 
ment and will keep indefinitely. 

Paper is also used for many purposes in the kitchen, 
and a supply of some kind should be on hand. “Kitchen 
paper may be purchased for a trifle. Grease-proof paper 
costs more. Any clean paper, free from printing, may 
be utilized in various ways in the kitchen. Newspapers 
should never be used around food. 


NOTES 


NOTES 


NOTES 


NOTES 


SECTION VIII 

SIX HUNDRED QUESTIONS FOR 
SELF-EXAMINATION AND REVIEW 

CHAPTER LVI 

QUESTIONS ON ANATOMY AND PHYSIOLOGY 

1. Define anatomy and physiology. 

2. What do you understand by the term “organ” as 
applied to the human body? 

3. What is the thorax and what are the principal organs 
contained in it? 

4. How is the thorax separated from the abdomen? 

5. What organs are contained in the abdominal cavity? 

6. Explain what is meant by mucous membrane, the 
cell, the skin, tissues. 

7. Name the chief systems into which the body may 
be divided. 

8. Into what two main classes may tissues be divided? 

9. What are the uses of osseous, connective, muscular, 
and cartilaginous tissues? 

10. Why is nerve-tissue considered of great importance 
in the body? 

11. How is the osseous system bound together? 

12. What is the function of the respiratory system? 

13. Give the two main divisions of the nervous system, 
and tell of what each consists. 

14. What do you consider the chief functions of the 
nervous system? 

15. Give a short description of the digestive system. 

493 



494 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 


16. What is the function of the excretory system, and 
what organs are concerned in it? 

17. Write a short description of the human skeleton. 

18. Describe the spinal column. 

19. What and how many bones form the framework of 
the chest? 

20. Define clavicle, scapula. 

21. Name the bones of the arm, including the wrist. 

22. What are the phalanges, and where are they found? 

23. Name the bones of the pelvis. 

24. Explain the terms “ acetabulum/’ “ symphysis 
pubis.” 

25. Define femur, trochanters, tibia, fibula, patella. 

26. Where are the tarsal and metatarsal bones found? 

27. Give a short description of the human skull. 

28. What are the uses of lime and gelatin in bone? 

29. What is the periosteum, the synovial membrane, 
and show the importance of each? 

30. Into what four main classes may bones be divided? 

31. Give, from your study of the skeleton, an example 
of each class. 

32. Define foramen, process, tuberosity, crest. 

33. What are muscles? Divide them into two main 
classes. 

34. Differentiate between voluntary and involuntary 
muscles, giving examples of each. 

35. Define flexors, extensors, tendons, aponeurosis, 
fascia. 

36. How is the erect position of the body maintained? 

37. Where are the pectoral muscles located? 

38. Locate the intercostal muscles, the diaphragm, the 
tendo Achillis. 

39. Mention the abdominal muscles and state their 
chief functions. 

40. Give an example of a hollow muscle. 

41. Explain the terms “ligament,” “capsule,” and 
“articulation” in the body. 

42. Give examples of movable and immovable joints. 

43. What is a gliding joint? Give an example. 


QUESTIONS ON ANATOMY AND PHYSIOLOGY 495 


44. Describe a ball-and-socket joint, giving illustra¬ 
tions. What is a pivot joint? 

45. Name two hinge-joints, and show how they differ 
from other joints. 

46. What are the uses of cartilage in joints? 

47. Explain the difference between mucous and serous 
membranes, and tell where each are found. 

48. Name the organs of the abdomen? 

49. What organs are contained in the pelvis? 

50. What and where is the esophagus? 

51. Write a short description of the stomach. 

52. What functions are performed by the gastric fluid? 

53. What are the chief constituents of the gastric 
fluid? 

54. What is the length of the intestinal canal in the 
adult? 

55. Name the divisions of the small and large intestines. 

56. Locate the vermiform appendix. 

57. What are Peyer’s patches, peristalsis? 

58. Describe -the liver, giving average weight, location, 
and general structure. 

59. Tell what you know of the functions performed by 
the liver. 

60. What are the chief uses of bile? 

61. What and where is the gall-bladder? 

62. What are the functions of the pancreas and spleen, 
and where is each found? 

63. What are the kidneys, and where are they located? 

64. What work do the kidneys perform in the body? 

65. Of what use are the ureters, and where are they 
found? 

66. Locate the adrenals, and tell what you know of 
their uses. 

67. Write short notes on the bladder, urethra, peri¬ 
toneum, umbilicus. 

68. Explain the term u abdominal viscera.” 

69. What do you understand by the terms “ epigastric 
and “ hypogastric regions”? 

70. Give a short description of the rectum and colon. 


496 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 


71. Explain what is meant by sigmoid flexure, anus, 
anal canal. 

72. What is respiration? 

73. What organs of the body constitute the respiratory 
system? 

74. Describe the trachea. 

75. Show how the mucous membrane which lines the 
trachea differs from that found in the mouth. 

76. Write a short paper on the lungs. 

77. What is the normal respiration and how would you 
determine the rate of respiration? 

78. How may the power of chest expansion be increased 
or decreased? 

79. What are the chief elements of the air? . 

80. Of what use is oxygen, nitrogen, carbonic acid? 

81. Explain the terms “tidal air,” “residual air.” 

82. What conditions tend to increase the amount of 
oxygen consumed in the body ? 

83. How is the exhalation of carbonic acid increased or 

decreased? 

84. Define asphyxia. 

85. How is the heat of the body produced? 

86. What is the average normal temperature of the 
body? 

87. How is heat thrown off by the body and the balance 
of heat controlled? 

88. Show how the superficial arteries assist in heat 
loss? 

89. What conditions may affect the body temperature 
in health? 

90. Describe the blood. How would you distinguish 
venous from arterial blood? 

91. What are the functions of the blood? 

92. What parts of the body constitute the circulatory 
system? 

93. Write a brief description of the heart. 

94. Define the pulse, and what is the average pulse-rate 
in the adult? 


QUESTIONS ON ANATOMY AND PHYSIOLOGY 497 

95. Describe the arteries, veins, and capillaries, showing 

•how they differ. 6 

96. Name four arteries in which pulsation may be felt, 
giving the location. 

97. What are the vena cavae, aorta? 

98. Describe the circulation of the blood, beginning 
with the right auricle. 

99. Into what three main kingdoms may world materials 
be divided? 

100. What causes waste of human tissue and how is it 
repaired? 

101. Name the four chief chemical elements in the com¬ 
position of the body. 

102. What are the chief mineral substances found in 
the body? 

103. How are these substances supplied to the body? 

104. Explain the terms “secretion,” “ excretion.” 

105. How is the waste of the body eliminated? 

106. Define digestion and give the different stages? 

107. What parts of the body constitute the digestive 
apparatus? 

108. How many teeth has an adult? What is saliva? 
Show how mastication influences digestion. 

109. What part does saliva perform in the digestive 
. process? 

110. Give a short description of gastric digestion. 
What food elements are acted on by the gastric fluids? 

111. What is chyme? What part of the digestive pro¬ 
cess is completed in the intestines? 

112. Give a summary of the process of digestion. 

113. Explain the terms “absorption,” “assimilation,” 

“ metabolism.” 

114. By what means is absorption accomplished? 

115. Tell what you know of the lymphatic system and 
its functions. 

116. What are the chief functions of the skin? 

117. Describe a healthy skin. 

118 . What are epithelial scales? 

32 


498 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

119. What glands are located in the skin and what work 
do they do? 

120. Write a short paper on perspiration. What are 
the appendages of the skin? 

121. Name and locate the organs which constitute the 
urinary system. 

122. What is the average quantity of urine discharged 
from the body in twenty-four hours? 

123. Describe normal urine. 

124. What are urea and uric acid? 

125. What conditions in health and disease influence the 
reaction of urine and the amount of urea and uric acid? 

126. What variations in the color of urine may take 
place in health, and from what causes? 

127. What changes in the urine would you expect fever 
to cause? 

128. Name six drugs which may affect the color of 
urine, and tell some changes produced by each. 

129. Explain the terms “specific gravity,” “reaction,” 
“micturition.” What is the normal specific gravity of 
urine? 

130. Which is the more serious, retention of urine or 
suppression, and why? 

131. What conditions tend to produce scantiness of 
urine? 

132. Give a brief description of the nervous system. 

133. Define nerve, nerve-center. What are motor and 
sensory nerves? 

134. What is the function of the cerebrum and where is 
it located? 

135. Locate the cerebellum and the medulla oblongata, 
and tell the function of each. 

136. Define pia mater, pons varolii. 

137. Describe the spinal cord, stating its function in the 
body. 

138. Explain the term “reflex action,” giving an ex¬ 
ample. 

139. What causes sensations? What do you under¬ 
stand by the term “general” or “common sensations”? 


QUESTIONS ON CHEMISTRY 


499 


140. What causes produce sleep? 

141. Name the organs of special sense. 

142. Give a general description of the eye. Explain the 
terms cornea/’ “retina/’ “iris/’ “accommodation.” 

143. How is the sense of touch produced? 

144. What parts of the body assist in producing the 
sense of taste? 

145. Where are the olfactory nerves? What function 
do they perform? What causes may weaken the olfactory 
nerves? 

146. Write a short paper describing the ear. Where are 
the Eustachian tubes, and what is their function? 

147. Where is the mastoid process? 

148. Show why the axilla or armpit is an important 
structure in surgical conditions. 

149. Into how many sections is the abdominal region 
divided for purposes of study, and name the divisions. 

150. Write short descriptive notes on the inguinal region, 
the rectum, bladder^ and vagina. 


CHAPTER LVII 

QUESTIONS ON CHEMISTRY 

1. Define Chemistry. 

2. Write a short paper outlining in a general way the 
field of chemistry and the part which it plays in our daily 
life. 

3. What are elementary substances and compounds? 

4. How many elementary substances have been dis¬ 
covered? Give a list of twenty which are commonly 
found in every-day life. 

5. Define atoms; molecules. How many kinds of 
atoms are found in a molecule of sugar? 

6. What do you understand by the term “chemical 
affinity”? 

7. What is an atomic symbol? 

8. Give the atomic symbols for magnesium, nitrogen, 



500 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

oxygen, phosphate, copper, silver, iron, carbon, calcium, 
hydrogen, iodin, bromin. 

9. How are atomic weights determined? 

10. Give a list of the appliances and supplies needed 
for simple experiments in a chemical laboratory. 

11. What is a formula in chemistry? 

12. Define valences; chemical reaction. 

13. What do you understand by the term “physical 
change”? Give two illustrations. 

14. Define biology; biologic changes. 

15. Explain the difference between physical and chem¬ 
ical changes. 

16. What do you understand by the term “oxidation”? 
How does it take place? 

17. Write a short paper on the chemistry of flame. 

18. What is the difference between oxidation and com¬ 
bustion? 

19. How is heat produced in the body? What be¬ 
comes of the products resulting from heat production? 

20. Write a short paper on ventilation, showing why 
it is necessary and what chemical changes are brought 
about in the air by opening a door or window admitting 
air from the outside. 

21. Define humidity and explain how and why the 
degree of humidity varies in different times and places. 

22. Mention four important elements found in all 
living matter. 

23. What elements are found when water is ana¬ 
lyzed? 

24. Mention some of the chief uses of nitrogen. Tell 
where it is found. 

25. What are the chief elements in kerosene, gasoline, 
and natural gas? 

26. Write short notes on carbon, chlorin, bromin. 

27. Mention two important compounds containing 
sulphur. 

28. Mention briefly some of the important commodi¬ 
ties containing sodium, and tell where it is found. 


QUESTIONS ON CHEMISTRY 


501 


29. What is potassium? Where is it found? Why 
is it an important element in daily life? 

30. What are the chief uses of calcium? Write the 
symbols for calcium carbonate. 

31. Where does phosphorus come from? In what 
structures of the body is it chiefly found? 

32. Why is phosphorus valuable in industrial life? 

33. Mention some of the destructive effects which 
may accrue to workers in the phosphorus industry. 

34. What are the chief uses of copper and silver as 
remedial agents? What effect is produced by using salt 
solution after an application of silver nitrate? 

35. What part does iron play in the human system? 

36. Give the important uses of mercury. 

37. Write brief descriptive notes on zinc, lead, boron, 
silicon, bismuth, caoutchouc, wax. 

38. Where are fats and oils obtained? 

39. Explain what is meant by an organic compound. 
Give one of the distinguishing peculiarities of organic 
elements and compounds. 

40. What is a carbon compound? Give illustrations 
of carbon compounds in common use. 

41. Explain the terms “solution,” “solute,” and “sol¬ 
vent.” 

42. How is a saturated solution obtained? 

43. Define deliquescence; effervescence. Give illus¬ 
trations of drugs in common use which exhibit these 
properties. 

44. Write a brief descriptive note on acids. 

45. What part is played by acids in the human body? 
How is the presence of an acid in a substance commonly 
determined? 

46. What is litmus, and what are its uses in chemistry? 

47. What acids would you expect to find in the fol¬ 
lowing substances—vinegar, grape-fruit, rhubarb, apples, 
grapes? 

48. How is lactic acid produced? 

49. Explain the terms “bases” and “salts” in chem¬ 
istry. 


502 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

50. Mention two chemical terms which are frequently 
used interchangeably with bases. 

51. What is the most important characteristic of 
bases? How are they formed? 

52. What is an alkali? Give some common illustra¬ 
tions of alkalies in daily use. 

53. What is the effect of alkalies on acids? 

54. Explain in a general way the process by which 
salts are produced. 

55. Mention some of the important uses of potassium 
chlorid and ammonium chlorid. 

56. What part is performed by salts in the nutrition 
of the body? 

57. Explain what is meant by incompatibility in 
chemistry. 

58. Make a list of the chemical constituents of the 
human body, giving the five most important elements 
first on the list. 

59. How are these substances taken into the body? 
How thrown off from the body? 

60. Define metabolism. Mention three diseases which 
result from disturbance in the metabolism of the body. 

61. Mention three elements necessary in repairing the 
waste of the body. 

62. What are the chief compounds required for the 
production of heat and energy in the body? Give a list 
of six articles of food in common use which contain these 
elements. 

63. How would you prove that carbon is oxidized in 
the body? 

64. What is a calorie? How are the caloric needs of 
the body determined? 

65. Show why the caloric needs of a child differ from 
that of an adult. 

66. What portions of the body are concerned in the 
production of digestive fluids? 

67. Write a short paper on enzymes, telling how pro¬ 
duced, their function in the body, and conditions under 
which they work best. How may they be destroyed? 


QUESTIONS ON CHEMISTRY 


503 


68. What is saliva? Describe its composition. What 
is its use? 

69. What glands are concerned in the secretion of 
sahva? Where are the openings of the ducts of these 
glands? 

70. Mention any circumstance which tends to retard 
or increase the secretion of saliva. 

71. What is ptyalin? How would you illustrate the 
action of ptyalin on certain food substances? 

72. What is gastric juice? Where and how is it 
formed? 

73. Mention the two most important enzymes com 
tained in the gastric fluid. 

74. What is glucose? Why is it sometimes given in 
solution intravenously? 

75. What organ is concerned in the secretion of the 
pancreatic fluid? 

76. Describe the ^action of the pancreatic fluid on 
various kinds of food. 

77. What is bile? Where is it prepared? What are 
its uses in the digestive process? 

78. What changes does the food undergo in the large 
intestine? 

79. Describe the action of the gastric fluid, the pan¬ 
creatic fluid, and the bile on fatty tissue. 

80. Mention an important acid constituent contained 
in the gastric juice. 

81. What effect would excessive secretion of this acid 
have on digestion? 

82. What are the important points to be determined 
by an examination of stomach contents? Mention two 
chemicals used in making such examinations. 

83. If the presence of undigested fat were found in a 
stool, what organ would you suspect as being the cause? 

84. Give the chemical constituents of urine. De¬ 
scribe two chemical tests used in examining urine. 

85. Explain the term “salt-balance.” 

86. Describe in a general way the effects produced by 
heat when applied to meat, coffee, bread dough. 


504 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

87. What changes must starch undergo before it can 
be utilized in the human system? 

88. State the chemical constituents of baking powder, 
and their effect when combined in food substances. 

89. What are yeasts? How are they produced? 

90. Describe some of the chemical reactions which 
take place in bread making. 

91. What chemical changes are produced in bread 
by toasting it? 

92. Mention three important alkalies commonly 
found in the household and their general uses. 

93. In what common articles of food are the following 
acids found—acetic, malic, tartaric, lactic? 

94. Where is oxalic acid obtained, and what are its 
chief uses? What care should be observed in using it, and 
why? 

95. What are molds and what conditions are necessary 
to their growth? 

96. What effect would you expect bichlorid of mercury 
to have on steel? 

97. What is the general effect of chlorid of lime on 
cotton; on metals? 

98. Mention three chemical compounds commonly 
used as solvents of grease. 

99. What general effects are produced by the use of 
strong alkalies on paint and varnish? Give reasons. 

100. How is soap made? Why is soap less effective 
when used in hard water? 


CHAPTER LVIII 
QUESTIONS ON HYGIENE 

1. What do you understand by the terms “ hygiene,” 
“ health,” “ sanitary” ? 

2. In investigating into the general conditions of any 
individual as relates to hygiene, what points would you 
consider? 

3. What would you regard as requirements to health? 



QUESTIONS ON HYGIENE 


505 


4. Show how germs are necessary to life and health. 

5. What are pathogenic germs and how are they 
spread? 

6. What do you regard as the most immediate essen¬ 
tial to life, and of wha£ does it consist? 

7. How is air contaminated? How purified? 

8. In providing for purity of air in any room, what 
points should be considered? 

9. Show why ventilation of a room is necessary to 
health. 

10. How is the blood purified? 

11. What qualities would you regard as essential to 
good drinking water? 

12. How may water become contaminated? How puri¬ 
fied? 

13. What changes are produced in water by boiling? 
How would you make boiled water palatable for drinking? 
How long should waterj^e boiled to render it safe for drink¬ 
ing purposes? 

14. Write a short paper on domestic filters, telling how 
they should be managed, giving reasons. 

15. Give four diseases that may be communicated by 
impure water or ice. 

16. Show how overeating may cause disease. What 
diseases are liable to be produced by deficiency in diet? 

17. Give three common methods of adulteration of milk. 

18. What do you understand by the term “ptomain 
poisoning”? Show how it may be caused by meats or fish. 

19. Explain how raw vegetables may become infected 
with disease germs. 

20. What would you consider as desirable and unde¬ 
sirable points in the location of a home or hospital? 

21. What would you regard as dirt from a sanitary 
standpoint? 

22. Show how flies and insects may become agents in 
spreading disease. 

23. What are the common constituents of dust? 

24. Explain why dust in a hospital ward should always 
be regarded as dangerous. 


506 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

25. What substances would you consider dangerous 
as sources of infection in a medical ward; what in a 
surgical ward? 

26. Show how a nurse may become a carrier of infec¬ 
tion from one patient to another. 

27. What general measures would you use to keep a hos¬ 
pital bathroom and service utensils in a sanitary condition? 

28. How would you render infected floors, carpets, 
and rugs sanitary ? 

29. Give one method that is recommended for destroy¬ 
ing insects. 

30. Write a short paper on the hygiene of the digestive 
system. 

31. Mention some important injurious effects that 
may result from neglect of teeth. 

32. Explain why regular and frequent cleansing of the 
skin is essential to health. 

33. What general effects are produced on health by 
a cold bath? 

34. Give reasons why mouth-breathing is injurious. 

35. What general measures would you recommend 
for the prevention of colds? What conditions predispose 
to this affection? 

36. How does compression of the chest affect the health 
injuriously? 

37. Write a paper outlining the general care a nurse 
should give her hands. 

38. Give three general rules which a nurse should 
observe in the care of her feet. 

39. What measures would you recommend for pre¬ 
serving the health of the eye? 

40. Name three common practices which you would 
consider injurious to the eye. 

41. In recommending a hygienic outfit of clothing for 
a woman what points would you consider? 

42. Describe what you would regard as the correct 
position for the body to assume in standing. 

43. What general precautions would you recommend 
to be observed when overheated? 


QUESTIONS ON BACTERIOLOGY 


507 


44. Give two reasons why nurses should refrain from dis¬ 
cussing their patients or their general work when off duty. 

45. Show why a certain amount of exercise in the open 
air and sunshine is important. 

46. Give four rules affecting the health, which you 
would recommend that nurses on night duty especially 
observe. 

47. Write a letter of advice to a girl of sixteen who is 
leaving home, describing how she should care for her 
health. 

48. Outline the general routine of living you would 
think important to observe in the care of a child of three 
years. 

49. State the conditions you would try to secure for 
yourself or your patients during sleeping hours. 

50. What degree of temperature would you regard as 

desirable for a sleeping room for a healthy person? What 
in a sick room? ^ 


CHAPTER LIX 

QUESTIONS ON BACTERIOLOGY 

1. Write short notes on the contributions of Pasteur, 
Lister, and Koch to bacteriology. 

2. What do you understand by the terms “bacteria” 
and “bacteriology”? What conditions are necessary for 
the growth of bacteria? 

3. Explain the terms “spore,” “fission,” “sapro¬ 
phytes,” “parasites.” 

4. To which of the great world kingdoms do bacteria 
belong? 

5. What good work is done by germs? Show why 
they are necessary to existence. 

6. Classify bacteria according to shape. 

7. How may germs be cultivated outside the body? 

8. What are bacilli? Name two diseases produced by 
bacilli. 



508 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

9. Where are germs found? 

10. Write a short paper, telling in your own language 
how you would explain the germ theory of disease. 

11. Define the terms “specific,” “ infectious/’ 

12. Show why the term “communicable” is more 
accurate than “infectious” or “contagious” in speaking 
of germ diseases. 

13. By what channels do germs enter the body? 

14. How is infectious matter cast off by the body? 

15. Name four diseases that may be acquired by con¬ 
tact. 

16. How do the germs of the following diseases get 
into the system: Measles, small-pox, influenza, typhoid 
fever, septicemia, abscess, gonorrhea, erysipelas? 

17. In what discharges are the germs of typhoid fever 
found? 

18. Show how flies may become carriers of disease. 

19. What general measures should a nurse use to avoid 
contracting typhoid fever while nursing a patient afflicted 
with it? 

20. What discharges from the body would you disinfect 
in caring for a case of diphtheria? 

21. How is tetanus contracted? 

22. What organs or structures of the body are liable 
to.be attacked by the tuberculosis germ? t- 

23. Write a short paper on methods of prevention of 
tuberculosis. 

24. How is malaria communicated from one person 
to another? 

25. What discharges would you disinfect in caring for 
patients afflicted with pneumonia, erysipelas, cerebro¬ 
spinal meningitis? 

26. What measures would you use in caring for a case 
of small-pox to prevent the spread of the disease? 

27. Explain the phrases, “incubation period,” “im¬ 
munity.” 

28. Show how natural immunity differs from acquired 
or artificial immunity. 

29. Name four germs frequently encountered in sur- 


QUESTIONS ON BACTERIOLOGY 


509 


& er y; giving illustrations of some of the results they 
produce in the body. 

30. Where are pus germs commonly found on a healthy 

body? J 

31. Show why surgical dressings should be protected 
from dust. 

32. Give three ways by which bacteria may be 
destroyed. Explain how an article may have been steril¬ 
ized and yet not be sterile. 

33. Write a short paper giving the elementary facts you 
have learned about asepsis. 

34. What is the difference between disinfection and 
sterilization? 

35. Define antiseptics, germicides, deodorants. Ex¬ 
plain the difference between asepsis and antisepsis. 

36. How is sterilization usually accomplished? 

37. What is the difference between ordinary cleanliness 
and surgical cleanliness? 

38. How would you sterilize surgical instruments, and 
how many minutes would you consider the process should 
take? 

39. Why is soda carbonate or bicarbonate sometimes 
added to the water used for sterilizing instruments? 

40. What are the advantages and disadvantages of 
baking as a means of sterilization? 

41. How long should surgical dressings and materials 
be exposed to live steam to render them aseptic? 

42. Name seven articles which you would not sterilize 
or disinfect by steam, giving reasons. 

43. What care would you use in packing a sterilizer for 
steam sterilization, and why? 

44. Explain what is meant by the term “ intermittent 
sterilization.” Why is intermittent sterilization some¬ 
times necessary? Show why it is rarely necessary in 
ordinary surgical work. 

45. In what diseases would you expect to encounter 
spore-bearing bacteria? 

46. Name seven points that should be considered in 
choosing a disinfectant. 


510 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

47. Write short notes on each of the seven points, show¬ 
ing when they should be considered. 

48. Name three substances which should not be disin¬ 
fected with bichlorid of mercury. What general value 
would you place on carbolic acid as a disinfectant, and 
what precautions would you exercise in its use? 

49. How may the air of a room be disinfected? What 
general precautions would you use in employing a gaseous 
disinfectant? Show why these precautions are necessary. 

50. What value would you place on cleanliness, dryness, 
and sunshine in the prevention of disease? What effect 
do these natural agents have on germ life? 


CHAPTER LX 

QUESTIONS ON THERAPEUTICS AND MATERIA MEDICA 

1. Define therapeutics. 

2. Classify the causes of diseases. 

3. Show how the term “action of remedy” is inaccu¬ 
rate. 

4. Explain what is meant by self repair. 

5. Give five common principles of treatment. 

6. What are natural remedies, and give reasons why 
these should be used as far as possible? 

7. Explain the difference between functional and or¬ 
ganic diseases. 

8. Name three common remedies derived from each 
of the three great kingdoms—animal, vegetable, and min¬ 
eral. 

9. What are prophylactic remedies? 

10. Give three remedial agents which may be classed 
as imponderable remedies. 

11. Define surgery, massage, materia medica, hydro¬ 
therapy. 



QUESTIONS ON THERAPEUTICS AND MATERIA MEDICA 511 


12. Explain the difference between pharmacy and 
pharmacology. What is toxicology? 

13. Define chemistry, pharmacopeia, dispensatory. 

14. What is the difference between official and unofficial 
drugs? 

15. Write the tables for apothecaries’ weights and 
measures, and give approximate measures. 

16. What is the difference between the minim and the 
drop? 

17. Explain the difference between alkaloids and al¬ 
kalies. 

18. What are salts, acids? Name three vegetable acids. 

19. Define cataplasma, cerates, chart. 

20. Show how decoctions differ from infusions. 

21. Explain what you mean by elixirs, extracts, emul¬ 
sions, glycerites, mixtures. 

22. What is the difference between fluidextracts and 
tinctures? 

23. What are suppositories, and how may they be 
given? 

24. What is meant by a saturated solution? 

25. Write the symbols for dram and ounce and the 
abbreviations for pint, minim, grains, and drops. 

26. What abbreviations would you use for: As you 
please; before food; twice a day; cubic centimeter; an 
eye-wash; let there be made; an hour; a pill; as occasion 
arises; through; let it be directed? 

27. Explain the difference between physiologic and 
therapeutic action. 

28. Give an illustration showing the difference between 
the primary and secondary action of drugs. 

29. What are stimulants and sedatives? 

30. Through what main channels do remedies produce 
their effects on the body? 

31. Show how surrounding conditions may sometimes 
defeat the action of a drug. 

32. Why are some drugs given before meals and some 
after meals? 


512 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

33. State briefly six conditions which may modify the 
action of drugs. 

34. What is a placebo? Give illustrations. 

35. Explain the terms“ idiosyncrasy,” “ accumulation.” 

36. Name ten drugs which sometimes produce a rash. 
Give two drugs which may affect the hearing. 

37. What do you understand by the term “the thera¬ 
peutic limit”? 

38. Give the average dose of dilute acids, fluidextracts, 
potent tinctures, solid extracts, spirits, infusions. 

39. How would you calculate the size of dose for a 
child? 

40. State seven ways in which medicines may be ad¬ 
ministered. 

41. What advantages have the stomach and hypoder¬ 
mic route for giving medicines over other methods? 

42. Show why drugs given in solution take effect more 
quickly. 

43. What would you suggest as the best time to give 
Epsom salts, and why? 

44. In the absence of definite orders as to time, what 
time would you give bitter tonics, and when would you 
give iron, arsenic, lithia, salol, soda? 

45. What do you consider the best time to give pills, 
cough medicines, and general systemic remedies? 

46. How would you give a fluid medicine to a baby; 
a pill to a child? What general rules would you observe 
in giving stimulants to children? What rules would 
you observe in giving effervescing powders? 

47. How would you give bismuth, bromid of potassium, 
sulphonal, tincture of chlorid of iron? 

48. What measures would you use to disguise the 
disagreeable taste of castor oil? 

49. In giving fluid medicines what general rules would 
you follow as regards dilution? Show why it is a safe 
rule to shake all bottles of fluid medicine before measuring 
a dose. 

50. Give six general precautions you would observe 


QUESTIONS ON THERAPEUTICS AND MATERIA MEDICA 513 


in giving all medicines. What special precautions should 
be observed in giving hypnotics? 

51. What general methods would you use in giving 
medicme to delirious, unconscious, and insane patients? 

52. At what temperature and in what form should 
medicines be for administration by rectum? What 
effects would you expect alcohol and fats, mingled with 
substances for rectal administration, to have on the 
rectum? 


53. What is the best position for the patient in giving 
medicine by rectum? 

54. For what reasons are rectal suppositories usually 
employed, and how would you give one? 

55. Why is the hypodermic method used? Tell how 
you would give a hypodermic injection. What care 
would you give a hypodermic syringe before and after 
using? 

56. How would you prepare to give steam inhalation 
to a child who had bronchitis? 

57. Describe the precautions which should be used 
in giving oxygen and the method of administration? 

58. State how medicines should be dropped into the 
eye, and the general precautions to be used in giving 
nursing treatments to the eye. 

59. Name three medicines commonly administered 
through the skin. 

60. How would you apply a fly-blister? 

61. What are the chief uses of the douche? 

62. What conditions or substances other than drugs 
may affect normal peristalsis? 

63. Give a list of foods which have a laxative effect. 

64. Give reasons why castor oil is a valuable purgative. 

65. Why is olive oil used? Give a list of four simple 
purgatives, telling what you know about each. 

66. Name four medicines which produce watery stools, 
and tell how you would give each one. 

67. What are intestinal astringents? Name three, 
and tell how they should be given. 

33 


514 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

68. How would you prepare and give a starch enema 
containing laudanum, and state the average dose of 
laudanum you think should be used. 

69. What are emetics, and why are they used? Name 
four, and tell how they should be given. 

70. For what purposes are diuretics given? Give four 
substances used as diuretics, and tell what you know 
about each. 

71. What are diaphoretics? What simple measures 
would you use to produce diaphoresis? 

72. How would you give a hot-air bath to a patient 
in bed? 

73. What general precautions would you use in giving 
pilocarpin, and why? 

74. Name four classes of stimulants, explaining the 
action each is expected to have. 

75. Give four reasons why cardiac stimulants are 
given. 

76. What general measures would you use to improve 
the condition of the heart in case of shock? 

77. What are the general effects of salt solution on the 
system? 

78. Show how tea and coffee exert a stimulating effect. 

79. Write short notes on ammonia, strychnin, digitalis, 
nitroglycerin, and adrenalin chlorid, giving the dose 
of each you would think safe if you had to give it in 
emergency. 

80. Tell what you know about alcohol as a heart 
stimulant. 

81. How would you know whether alcohol was or was 
not having a good effect on the patient? 

82. How much alcohol does whisky contain? 

83. What proportions of alcohol and water should 
be used in making dilute alcohol? 

84. Name two drugs sometimes prescribed as cardiac 
sedatives. 

85. What is an average dose of tincture of aconite? 
Give the signs of overdosing. 


QUESTIONS ON THERAPEUTICS AND MATERIA MEDICA 515 

86. What would you consider dangerous symptoms 
in using veratrum viride, and what would you do? 

87. Define and classify nerve sedatives. 

88. What simple measures could you use to relieve 
insomnia before resorting to drugs? 

89. How does chloral hydrate act, and how would you 
give it? What bad effects sometimes follow its use? 

90. What is an average dose of hyoscin hydrobromate? 

91. Write short notes on sulphonal and trional, and 
tell how you would give them? 

92. State the effects you would expect paraldehyd to 
produce, and the average adult dose. 

93. How do bromids act, and what bad effects do 
they sometimes produce? 

94. Give the general effects of opium and four prepara¬ 
tions of the drug? 

95. Why is morphin often combined with atropin, 
and what is the average adult dose of each? 

96. How does codein differ from morphin in its 
general effects? 

97. How much opium does an ounce of laudanum 
contain. What would you consider a safe and a fatal 
dose of laudanum for a two-year-old child. What is the 
difference between a minim and' a drop of laudanum? 

98. Compare laudanum and paregoric as to strength 
and average adult dose. 

99. Give the signs of opium-poisoning and the common 
antidotes used. 

100. For what purposes are salol and sodium salicylate 
used? 

101. What good and ill effects would you expect ace- 
tanilid to produce? 

102. What is an average dose, and what are the general 
uses of phenacetin? 

103. Name three drugs, besides opium, that are some¬ 
times used for the relief of pain. 

104. What are anesthetics and for what purposes are 

they used? 


516 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

105. Why is ether usually preferred to chloroform? 

106. How is cocain used, and how should it be prepared 
for hypodermic injection? 

107. What common substances, apart from drugs, may 
be used as local anesthetics? 

108. Define tonics, and name three drugs used as general 

tonics. 

109. What would you include under the term 11 natural 
tonics”? 

110. Show how attractive food acts as a tonic. 

111. How may appetite be destroyed? 

112. Write a short paper on pepsin. 

113. What is an average dose of dilute hydrochloric acid? 

114. What food elements are acted on by pancreatin? 

115. On what substances does diastase act as a digestive 
agent? 

116. For what purpose is iron given? 

117. What ill effects would you expect from large doses 
of iron? 

118. How would you disguise a dose of cod-liver oil? 

119. What effect does cod-liver oil produce on the body? 

What time in relation to meals would you give it? 

120. Name three bitter tonics. 

121. Tell what you know about quinin. 

122. Define antiseptics and germicides. 

123. Show how ice exerts an antiseptic action. 

124. What effect does salt or sugar have on vegetable 
matter? 

125. How would you make normal salt solution, and 
for what purposes is it chiefly used? 

126. What strength of solution of boracic acid is suf¬ 
ficient to arrest the growth of bacteria? How would you 
make a saturated solution? 

127. What is peroxid of hydrogen, and for what pur¬ 
poses is it used? 

128. How much carbolic acid would you use to make 
a pint of a 3 per cent, solution? Name two antidotes for 
carbolic acid. 


QUESTIONS ON THERAPEUTICS AND MATERIA MEDICA 517 

129. Write a short paper on corrosive sublimate, and 
include what you would consider the important points 
which a nurse should know about it? 

130. What strength of solution of lysol would you 
employ for hand disinfection, and what effects would you 
expect a too strong solution to produce on the skin? 

131. In using formaldehyd for fumigation what amount 
would you use, and what general precautions should be 
taken in preparing a room for such fumigation? 

132. How would you use formaldehyd in combination 
with permanganate of potassium for fumigation? How 
without it? What rule would you observe in computing 
the quantity of the drug needed for disinfection? 

133. What advantages and disadvantages is sulphur 
said to have as a disinfecting agent, and how would you 
use it? 

134. On what substances is milk of lime used as a dis¬ 
infectant, and how would you use it? 

135. How would you calculate the amount of salt needed 
to make a quart of a 5 per cent, solution? 

136. What are the symptoms of salivation? Name 
two drugs that sometimes cause it. 

137. What general effects are produced by iodid of 
potassium? How would you give it? 

138. What is antitoxin? 

139. For what purposes is ergot chiefly used? 

140. How would you make flaxseed tea? 

141. What are the uses of mustard? 

142. State three purposes for which turpentine is used. 

143. Write short notes on capsicum; hops. 

144. Of what value is camphor as a remedy? 

145. How would you make lime-water? 

146. Classify poisons, and tell how the different classes 
act. 

147. Tell what you would do in a case of poisoning by 
carbolic acid. 

148. How would you proceed in a case of laudanum¬ 
poisoning? 


518 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 


149. What emeties would you use in a case of corrosive 
sublimate poisoning? 

150. What symptoms would lead you to suspect poison¬ 
ing by strychnin, and what would you do in such a case? 


CHAPTER LXI 

QUESTIONS ON DIETETICS AND INVALID COOKERY 

1. What processes are concerned in the nutrition of 
the body? 

2. Define foods. What constitutes a perfect food? 

3. What are the uses of water in the body? 

4. Name the most important food compounds. 

5. What functions do nitrogenous foods perform in 
the body, and what are the uses of non-nitrogenous foods? 

6. Classify foods according to their alimentary prin¬ 
ciples. 

7. Name the principal nitrogenous food substances 
and tell where each is obtained. 

8. What are carbohydrates? 

9. Name two animal and two vegetable foods which 
contain fat. 

10. What foods would you give a child who needed 
more mineral matter? 

11. Name the chief tissue-building foods, and the chief 
heat- and force-producing foods. 

12. What vegetables contain little or no starch? 

13. Prepare a day’s menu for a patient, excluding 
starchy foods as far as possible, while giving variety. 

14. What do you consider the three most immediate 
necessities of life? Why is air classed as a food? 

15. What becomes of excess of food that is eaten? 

16. What useful function may be performed by the 
indigestible parts of vegetables? 



QUESTIONS ON DIETETICS AND INVALID COOKERY 519 

18. Define the terms “protein,” “albuminoids,” “gela- 
tinoids,” “proteid,” “extractives,” “dextrin,” “lactose.” 

19. Show how the nutritive value of food is not the 
same in different individuals. 

20. What would you consider an ideal diet? 

21. Show why a mixed diet is advisable. 

22. What conditions should be considered in deciding 
as to the amount of food required? 

23. What should the diet for an individual’s first two 
years consist of? 

24. Give a list of foods which should be excluded from 
the diet of a child of three years. 

25. Prepare two day’s menu for a three-year-old child, 
giving reasonable variety. 

26. What general rules should be observed in feeding 
children? 

27. Give some conditions which should influence the 
diet during active adult life? 

28. What results would you expect from overeating? 

29. In arranging a diet for the period of advanced age 
what changes would you make from the diet suitable for 
active adult life? 

30. Why would you make these changes? 

31. Name seven conditions which may influence the 
digestibility of food. 

32. In the cooking of food, what objects are aimed at? 

33. How would you boil a piece of beef if you wished 
to prepare the meat to be used as food? 

34. Give a rule for making beef broth. 

35. What parts of beef would you consider stewing 
best suited for? 

36. Name two points which should be specially observed 
in roasting meat. 

37. Describe the proper method of broiling a beefsteak. 

38. Divide soups into four classes and explain the 
difference between them. 

39. Show why thorough cooking of starchy foods is 
very important. 


520 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

40. Give three reasons why milk is not a perfect food 
for adults. 

41. Why is milk of special value as a food for invalids? 

42. Compare the food value of milk, beef, and bread. 

43. What causes milk to become sour? Show why 
extreme care should be used to keep milk clean. 

44. Compare skimmed milk and buttermilk with whole 
milk as to food value. 

45. What do you mean by the pasteurization of milk? 
Why is it practised? 

46. Why is lime-water added to milk? 

47. Give four methods of varying a milk-diet. 

48. What measures would you use to prevent milk 
disagreeing with a patient who disliked it? 

49. Give one method of predigesting milk. 

50. What is junket and how would you make it? 

51. How would you prepare albumen water, eggnog, 
omelet? 

52. Prepare a day’s menu of at least six meals for a 
patient with mild fever, excluding milk, but giving as 
much variety as permissible in a fluid diet. 

53. Compare beef, mutton, pork, and chicken as to 
digestibility. 

54. What are sweetbreads, and how would you pre¬ 
pare and serve them? 

55. What parts of beef give first, second, and third 
quality of meat? 

56. Show why liver and kidney are not suitable meats 
for invalids. 

57. Of what use is gelatin as food? 

58. Compare salmon with white fish as to diges¬ 
tibility. 

59. Compare a quart of oysters and the same amount 
of milk as to cost and food value. 

60. Write a bill of fare for the nurse’s table, including 
eight articles of food. Show how these eight articles 
contain all the important food elements. 

61. What cereals are chiefly used as human food? 


QUESTIONS ON DIETETICS AND INVALID COOKERY 521 

62. Compare the three common varieties of bread as' 
to food value. 

63. What effect does toasting have on the digestibility 
of bread? Describe briefly a badly made piece of toast, 
and show why it should not be served to invalids. 

64. What is macaroni, and what is its general worth 
as a food? Give one method which you would recommend 
for cooking it. 

65. Write a short paper on breakfast foods. 

66. Why is thorough cooking especially important - in 
cereal foods and not in flesh foods? 

67. Give a list of nutritive and of flavor vegetables. 

. 68. Of what use is rice as food? What are legumes? 
Of what use are they as foods? 

69. How would you cook potatoes for an invalid so 
as to have them most easily digested? 

70. Show why green vegetables which contain very 
little nourishment are yet essential to health. 

71. Of what use is sugar as food? What results are 
produced when an excess of sugar is taken? 

72. In what kinds of diseases or patients are sugars 
forbidden or used very sparingly? What is saccharin? 

73. What are the uses of fruits in the diet? 

74. Give a list of fruits you would consider easily 
digested; also a list of those containing most nutriment. 

75. Compare nuts with apples as to digestibility. 

76. What are condiments, and what are their uses in 
the diet? Name the principal condiments. 

77. Name the two common beverages which contain 
tannin. How is it extracted? 

78. How does green tea differ from black tea? How 
should tea be made? 

79. What good and bad effects are attributed to the 
use of tea? 

80. Give a rule for making coffee for an invalid. What 
are the good and bad effects produced by coffee on the 
system? What are the active stimulating elements in 
tea and coffee? 


522 QUESTIONS FOR SELF-EXAMINATION AND REVIEW 

81. How does cocoa compare with tea and coffee as to 
nutritive value? How would you prepare cocoa? 

82. Show why fluid diet is preferred as a food in fevers. 

83. Give the general principles which are considered 
in the diet in acute fevers. 

84. Why should abundance of water be given to such 
patients? 

85. How would you alter milk so as to increase its 
digestibility for fever patients? 

86. What conditions would you consider essential to 
success in food serving? 

87. How may a nurse promote the comfort of a weak 
convalescent patient while taking his food? 

88. Give the general principles which would guide you 
in feeding helpless patients. 

89. How would you prepare scrambled eggs and toast? 

90. Give three methods of preparing toast; three sand¬ 
wiches which you would consider wholesome for invalids. 

91. Write two bills of fare each for breakfast for a 
hearty invalid in August, and in December. 

92. Prepare potato puree, baked rice pudding, jelly 
from calves feet, and oyster stew. 

93. What are croutons? How would you make and 
serve mutton broth to an invalid? 

94. Outline two day’s menu for a patient who was 
allowed solid foods, but no meat of any kind. 

95. How would you prepare and serve mutton chops, 
scraped beef, beef juice? 

96. Give two ways of preparing rice to be used as a 
vegetable. 

97. Write the rules for preparing three desserts you 
would use in feeding a typhoid fever patient during 
convalescence. 

98. Give two methods of preparing prunes. 

99. Give a list of fruits you would recommend for 
their laxative effect. 

100. Prepare and serve a cottage-cheese salad; a fruit 
salad. 


Appendix 


THE METRIC SYSTEM 


WEIGHTS 


1 

1 

1 

1 

1 

1 

1 


milligram = 

0.001 

gram 

centigram = 

0.01 

it 

decigram = 

0.1 

n 

gram — 

1.0 

tt 

decagram — 

10.0 

grams 

hectogram = 

100.0 

a 

kilogram = 

1000.0 

it 


LENGTHS 

1 millimeter = 0.001 meter 
1 centimeter = 0.01 “ 

1 decimeter — 0.1 “ 

1 meter =1.0 “ 


CAPACITY 


1 milliliter 
1 centiliter 
1 deciliter 
1 liter (1.) 


= 0.001 
= 0.01 
= 0.1 
= 1.0 


liter 

ft 

It 

it 


APPROXIMATE EQUIVALENTS 


1 CC. 

4 CC. 

30 cc. 

1 gram 
1 decigram 
1 centigram 
1 milligram 
1 liter 
1 kilo 
1 cm. 


= 15 minims 
= 1 fluidram 
= 1 fluidounce 
= 15£ grains 

= H “ 

= £ gram 

= * “ 

= 1 quart 

= 2\ pounds avoirdupois 
— $ inch 


523 



524 


APPENDIX 


PHYSIOLOGIC SALT SOLUTION 


Sodium chlorid.gr. 50 

Potassium chlorid.gr. 3 

Sodium sulphate \ gr- 25 

Sodium carbonate J 

Sodium phosphate. .gr. 2 

Boiling water.gr. 1 


HOUSEHOLD ANTIDOTES 1 


For bedbug poison 
For corrosive sublimate 
For blue vitriol 
For lead-water 
For saltpeter 
For sugar of lead 
For sulphate of zinc 
For red precipitate 
For vermilion 


Give milk or white of eggs, large quan¬ 
tities. 


For Fowler’s solution 
For white precipitate 
For arsenic 

For antimonial wine 
For tartar emetic 

For oil of vitriol 

For aqua fortis 

For bicarbonate of potash 

For muriatic acid 

For oxalic acid 

For caustic soda 

For caustic potash 

For volatile alkali 

For carbolic acid 

For chloral hydrate 
For chloroform 

For carbonate of soda 

For copperas 

For cobalt 

For laudanum 

For morphin 

For opium 

For nitrate of silver 

For strychnin 

For tincture of nux vomica 

For iodin and iodids 


} Give prompt emetic of mustard and 
salt, tablespoonful of each; follow 
with sweet oil, butter, or milk. 

{ Drink warm water to encourage vomit¬ 
ing. If vomiting does not stop, 
give 1 grain of opium in the water. 

] Magnesia or soap, dissolved in water, 
every two minutes. For oxalic 
}- acid, give calcium carbonate or 
hydrate (lime-water, chalk, wall- 
J plaster, in water). 

} Drink freely of water with vinegar or 
lemon juice in it. 

f Give flour and water, glutinous drinks, 
\ and a form of alcohol. 

{ Pour cold water over the head and 
face, with artificial respiration; gal¬ 
vanic battery. 

} Prompt emetics; soap or mucilaginous 
drinks. 

( Strong coffee, followed by ground mus¬ 
tard or grease in warm water to pro¬ 
duce vomiting. Keep in motion. 

} Give common salt in water. Emetic 
of mustard or sulphate of zinc, aided 
by warm water. 

f Prompt emetic; solution of starch; 
\ flour and water. 


1 Table of Household Antidotes quoted from Pocket Cyclopedia 
of Medicine and Surgery , Gould and Pyle. 








APPENDIX 


525 


TABLE OF BONES 


Skull {cranium) 

Frontal. 1 

Occipital. 1 

Parietal. 2 

Temporal. 2 

Sphenoid. 1 

Ethmoid. 1 


Face 

Nasal. 2 

Malar. 2 

Inferior turbinated. 2 

Maxilla. 2 

Lacrimal. 2 

Palate. 2 

Vomer. l 

Mandible. 1 


UPPER EXTREMITIES 


Clavicle. 2 

Scapula. 2 

Humerus. 2 

Radius. 2 

Ulna. 2 

Metacarpal.10 

Phalanges.28 

Trunk 

Ribs.24 

Os hyoid. 1 

Sternum. 1 


Trunk {vertebras) 


Cervical vertebrae. 7 

Dorsal vertebrae.12 

Lumbar vertebrae. 5 

Sacral (5). 1 

Coccygeal (4). l 

Carpal 

Scaphoid. 2 

Semilunar. 2 

Cuneiform. 2 

Pisiform. 2 

Trapezium. 2 

Trapezoid. 2 

Os magnum. 2 

Unciform. 2 


LOWER EXTREMITIES 


Os innominatum. 2 

Femur. 2 

Patella. 2 

Tibia. 2 

Fibula. 2 


Tarsal 

Os calcis. 2 

Astragalus. 2 

Cuboid. 2 

Navicular. 2 

Internal cuneiform. 2 

Middle cuneiform. 2 

External cuneiform. 2 

Metatarsal.10 

Phalanges.28 

Total..200 


TEMPERATURE 

The two methods of expressing degrees of heat and cold (Centi¬ 
grade and Fahrenheit) are expressed by the symbols C. and F. re¬ 
spectively. 

The freezing-point of water (32° F.) is the zero point of the Centi¬ 
grade scale. The boiling-point of water (212° F.) is equal to 100° C. 























































526 


APPENDIX 


To reduce Centigrade degrees to those of Fahrenheit, multiply by 
9, divide by 5, and add 32. 

To reduce Fahrenheit degrees to the Centigrade scale, subtract 32, 
multiply by 5, and divide by 9. 


TABLES FOR COOKING 

A speck makes one-quarter saltspoonful. 

Four saltspoonfuls make one teaspoonful. 

Two gills make one cupful. 

One wineglassful makes one-half cupful. 

Ten eggs, average size, make one pound. 

One tablespoonful of butter makes one ounce. 

One tablespoonful of granulated sugar makes one ounce. 

One scant pint of granulated sugar makes one pound. 

One pint of butter makes one pound. 

One cupful of rice makes one-half pound. 

One cupful of stale bread-crumbs makes two ounces. 

A spoonful means that the material should lie as much above the 
edge of the spoon as the bowl sinks below it. A heaping teaspoon¬ 
ful means that the material should be twice as high above the edge 
of the spoon as the bowl sinks below it. A level teaspoonful should 
hold sixty drops of water. All dry materials are measured after 
sifting. 

A spoonful of salt, pepper, soda, or spices, should be level. 

One-half of a spoonful is measured by dividing through the middle 
lengthwise. 

TIME FOR BROILING 


Steak, 1 inch thick. . 
Steak, 2 inches thick 
Fish, small and thin. 

Fish, thick. 

Chicken. 


4 to 6 minutes 
8 to 15 

5 to 8 “ 

15 to 25 

20 to 30 







INDEX OF DRUGS 


Acetanilid, 327 
Acid, boracic, 169, 330 
carbolic, 330 
citric, 173, 261 
hydrochloric, 319 
oxalic, 173, 334 
salicylic, 327 
tannic, 302 
tartaric, 173, 261, 300 
Acids, 172, 173, 184, 261 
Aconite, 316 
Adrenalin chlorid, 312 
Albolene, 338 
Alcohol, 313 
Ale, 314 
Alkalies, 261 
Alkaloids, 261 
Aloin, 299 
Alum, 303 
Ammonia, 308, 312 
aromatic spirits of, 312 
Amyl nitrite, 290 
Anesthetics, 328 
Antidotes, 341, 343 
household, 524 
Antipyretics, 327 
Antiseptics, 243, 329 
Antitoxins, 240 
Apomorphin, 303 
Apothecaries’ weight, 259 
Approximate equivalent, 260 
Argyrol, 168 
Aristol, 337 


Arnica, 339 
Asafetida, milk of, 301 
Astringents, 301 
Atropin, 272 

Beer, 314 

Belladonna, 292, 299, 308 
Bichlorid of mercury, 168 
Bismuth, 169, 301 
Black wash, 337 
Blue mass, 336 
Boracic acid, 169, 330 
Borax, 330 
Boron, 169 
Brandy, 314 
Bromids, 325 
ammonia, 325 
potassium, 325 
sodium, 325 
Bromin, 166 
Bromos, 166 

Caffein, 305, 310, 312 
Calcium, 167, 353 
Calomel, 336 
Camphor, 291 
Caoutchouc, 169 
Capsicum, 340 
Cardamom, 301 
Carminatives, 301 
Caroid, 320 
Carron oil, 339 
Cascara, 297, 298 






528 


INDEX OF DRUGS 


Cerates, 262 
Champagne, 314 
Chloral hydrate, 324 
Chloretone, 328 
Chlorid of lime, 334 
Chlorin, 166 
Chloroform, 328 
Cinchona, 321 
Claret, 314 
Cocain, 328 
Cocoa, 407 
Codein, 326 
Cod-liver oil, 320 
Coffee, 310, 406 

Compound licorice powder, 298 
rhubarb pill, 299 
tincture of opium, 326 
Copper, 168 

Corrosive sublimate, 331, 337 
Cream of tartar, 300, 304 
Creolin, 331 
Croton oil, 299 

Diaphoretics, 306 
Diastase, 320 
Digitalis, 304, 312 
Dilute alcohol, 314 
hydrochloric acid, 319 
Diuretin, 305 
Duboisin, 292 

Elaterium, 299 
Epsom salt, 300 
Ergot, 339 
Eserin, 292 
Ether, 328 
Ethyl chlorid, 328 

Ferrum, 162, 320 
Flaxseed, 339 
Fluidextracts, 262 
Fly blister, 293 


Formaldehyd, 208, 332 
Formalin, 332 

Gentian, 321 
Ginger, 340 
Glonoin, 311 
Glycerin, 338 
Guaiacol, 328 

Hexamethylenamin, 305 
Hops, 340 

Household antidotes, 524 
Hydrochloric acid, 319 
Hyoscin hydrobromate, 324 

Iodin, 167, 337 
Iodoform, 337 
Ipecac, 303 
Iron, 168, 320 

Jaborandi, 307 
Jalap, 300 

Labarraque’s solution, 206 

Lactose, 359 

Lanolin, 338 

Laudanum, 326 

Lead, 169 

Lime, 334 

Lime-water, 340 

Linseed, 339 

Lysol, 331 

Magnesia citrate, 300 
sulphate, 300 
Mercury, 168, 336 
Milk of asafetida, 301 
of lime, 334 
Mineral waters, 299 
Morphin, 326 
Mustard, 341 



INDEX OF DRUGS 


529 


Mydriatics, 292 
Myotics, 292 

Narcotic poisons, 341 
Nitrate of silver, 302 
Nitroglycerin, 311 
Nitrous oxid, 328 
Nux vomica, 311 

Oil, carron, 339 
castor, 297 
cod-liver, 320 
olive, 298 
turpentine, 341 
Oils, administration of, 277 
Opium, 325, 326 
poisoning by, 327 
Oxalic acid, 334 

Pancreatinin, 319 
Papoid, 320 
Paraldehyd, 325 
Paregoric, 326 
Pepper, 340 
Peppermint, 301 
Pepsin, 180, 319 
Peroxid of hydrogen, 330 
Phosphorus, 168 
Pills, administration of, 276 
Pilocarpin, 307 
Pituitary extract, 126 
Poisons, 341 
Port wine, 314 
Porter, 314 

Potassium bitartrate, 304 
bromid, 325 
citrate, 304 
iodid, 336, 337 
permanganate, 334 
Powders, 277 
Pumpkin seeds, 301 
34 


Quicksilver, 336 
Quinin, 331 

Red wine, 314 
Rennet, 320, 387 
Rhubarb, 299 
Rochelle salt, 261, 300 

Saccharin, 403 
Salicylic acid, 327 
Salol, 327 
Salt, common, 329 
Epsom, 300 
Rochelle, 261, 300 
solution, 310 
Sanitas, 341 
Santonin, 300 
Seidlitz powder, 300 
Sherry, 314 
Silicon, 169 
Silver, 168 
nitrate, 302 
Sodium borate, 330 • 

bromid, 325 
chlorid, 329 
Solution table, 335 
Spartein sulphate, 312 
Specifics, 336 

Spirits, aromatic, of ammonia, 
312 

of camphor, 291 
of nitrous ether, 308 
Strophanthus, 312 
Strychnin, 311 
Sugar of milk, 359 
Sulphonal, 324 
Sulphur, 167, 333 
Sulphuric ether, 328 
Suppositories, 284 
Sweet spirit of niter, 308 
Syrup of ipecac, 303 



530 


INDEX OF DRUGS 


Taka-diastase, 320 
Tannic acid, 302 
Tartaric acid, 173, 261, 300 
Tea, 310, 405 
Tinctures, 262 
Trional, 324 
Turpentine, 341 

Urotropin, 305 

Vaselin, 338 
Vegetable bitters, 321 


Veratrum viride, 316 
Vinegar, 261 

Waters, mineral, 299 
Wax, 169 
Whisky, 31 4 
Wines, 314 

Yellow wash, 337 

Zinc, 169 
Zingiber, 340 



INDEX 


Abbreviations and symbols, 263 
Abdomen, 151 
massage of, 297 
organs of, 68 

Abdominal cavity, 30, 31, 70, 154 
organs of, 68 
inguinal ring, 155 
muscles, 55 
regions, 75, 151 
wall, 152 
Abductors, 59 
Abscess of breast, 150 
of prostate gland, 156 
Absorption, 109 
Absorptive system, 110, 111 
Accommodation, 139 
Acetabulum, 47 
Acetanilid, 327 
Acid, 261 
acetic, 173 
boracic, 169, 330 
butyric, 173 
carbolic, 330 
citric, 173, 261 
hydrochloric, 319 
lactic, 173 
malic, 173 
oxalic, 173, 334 
salicylic, 327 
tannic, 302 
tartaric, 173, 261, 300 
uric, 182 

Acids, 172, 173, 184, 261 


Aconite, 316 
Action, physiologic, 266 
reflex, 134 
systemic, 303 
local, 303 
therapeutic, 267 
Adductors, 59 
Adenoids, 148 
Adrenalin chlorid, 312 
Adrenals, 75, 125, 126 
Adults, • normal, energy require¬ 
ments for, 356 
Affinity, chemical, 159 
Air, 88, 189, 322 
Air-borne theory of disease, 232 
Albumin in urine, 116 
tests for, 116 
Alcohol, 313 
effects of, 313 
physiologic effects of, 315 
Alimentary tract, 69, 105 
Alkalies, 173, 184, 261 
Alkaloids, 261 
Alum, 303 
Alveolar process, 50 
Ammonia, 308, 312 
Anabolism, 111 
Analysis, 170 
Anatomy, 29 
questions on, 493 
surgical, notes on, 145 
Anesthetics, 328 
Animal life, 35 






532 


INDEX 


Animals, farm, balanced feeding 
for, 367 

Antidotes, 341, 343 
household, 524 
Antipyretics, 327 
Antiseptics, 243, 329 
Antitoxin, 240 
Anus, 76 
Apoplexy, 98 

Apothecaries’ measure, 260 
weight, 259 
Appetite, 318 

Approximate measures, 260 

Aqueous humor, 138 

Argyrol, 168 

Armpit, 148 

Arnica, 339 

Arteries, 96, 99, 100 

Arteriosclerosis, 96 

Artificial food products, 367 

Asepsis, 246 

Aseptic conscience, 247 

Asphyxia, 88 

Atlas, 42 

Atom, 158 

Atomic symbols, 159 
weight, 159 
Atropin, 272 
Auditory nerve, 144 
Auricles, 93 
Axilla, 148 
Axillary glands, 127 
Axis, 42 

Bacon, 387 
Bacteria, 185, 226 
classification of, 227 
cultivation of, 229 
destruction of, 208, 242 
grouping of, 229 
growth of, 227 
in milk, 379 


Bacteria in surgery, 241 
location of, 230 
spores of, 226 
Bacteriology, 221 
historical notes, 221 
nursing and, 221 
questions on, 507 
Balanced feeding for farm ani¬ 
mals, 367 

Ball-and-socket joints, 57 
Bases, 172, 173 
Baths, 123 
Beef, cuts of, 392 
Beer, 314 

Beverages, 405, 425 
Biceps muscle, 58 
Bichlorid of mercury, 168 
Bile, 73, 127, 181 
Biologic change, 163 
Biology, 163 
Bismuth, 169, 301 
Bladder, 75, 112, 155 
Blood, composition of, 91 
course of, 102 
uses of, 92 
Blood-pressure, 97 
testing of, 97 
Blood-vessels, 96 
nerve-supply of, 103 
Blushing, 103 
Body builders, 176 
dorsal surface, 29 
general construction of, 29 
median line, 29 
regulators, 176 
ventral surface, 29 
work of, 364 
Bones of skeleton, 42 
table of, 525 
Boracic acid, 169, 330 
Borax, 169, 330 
I Boron, 169 






INDEX 


533 


Brain, functions of, 130 
parts of, 131 
as food, 388 

power and phosphorus, 390 
Bread, 377 
Breast bone, 44 
Breasts, 127, 149 
abscess of, 150 
Broad ligaments, 78 
Broiling, time for, 526 
Bromids, 325 
Bromin, 166 
Bromos, 166 
Bronchi, 83 
Buccal cavity, 31, 104 
Buttermilk, 297, 380 
Butyric acid, 173 

Calcium, 167, 353 
Calf’s feet and head, 388 
Caloric needs of adults, 178 
of body, 178 
Calorie, 177 

Calorific values, table of, 179 
Calorimeter, respiratory, 178, 358 
Camphor, 291 
Canal, spinal, 30, 31 
Candy habit, 403 
Caoutchouc, 169 
Capillaries, 96 
Capsule, 59 
Capsules, 262 
suprarenal, 75 
Carbohydrates, 177, 355 
Carbon, 166 
compounds, 170 
dioxid, 166 

Cardiac sedatives, 315 
stimulants, 308 
Carriage, 219 
Cartilage, 38, 49, 62, 63 
Cascara, 297, 298 


Casein, 355 
Castor oil, 297 
Casts in urine, 117 
Catabolism, 111 
Cavities of body, 30, 31 
Cecum, 71 
Cell, 33 
division, 34 
mastoid, 146 
Cereal products, 367 
Cerebellum, 131 
Cerebrospinal fluid, 30 
meningitis, 236 
system, 128 
Cerebrum, 131 
Cervical vertebrae, 42 
Cheese, 380 
Chemical affinity, 159 
and physical changes, 163 
compounds, 353 
constituents of urine, 181 
elements, 40 
equation, 163 
reaction, 162 

Chemistry and cleaning, 184 
definition, 157 
elementary, 157 
field of, 157 

fundamental laws and prin¬ 
ciples, 161 
of body, 304 
of cooking, 182 
physiologic, 175 
questions on, 499 
synthetic, 170 
Chemists’ symbols, 162 
Chest, 44 
Chicken-pox, 234 
Children, normal, energy require¬ 
ments of, 356 
Chloral hydrate, 324 
Chlorin, 166 







534 


INDEX 


Chlorinated lime, 334 
Chloroform, 328 { 

Cholera, 234 1 

Chyle, 111 ' 

Chyme, 107, 108 
Chymification, 107 
Ciliary muscle, 138 
Circulation of blood, 102 
coronary, 99 
pulmonary, 99 
Circulatory system, 101 
Citric acid, 173 
Clavicle, 44 

Cleaning and chemistry, 184 
Clothing, 213, 218 
Coccyx, 46 
Cocoa, 407 
Coffee, 310, 406 
Cold, 103 
Collar-bone, 44 
Combustion, 164, 165 
Common sensations, 134 
Communicable diseases, control 
of, 250 

Compounds and elements, 165 
carbon, 170 
organic, 169 
Condiments, 405 
Conjunctiva, 140 
Consomme, 376 
Contact infection, 240 
Conversion of starch into sugar, 
182 

Cooking, chemistry of, 182 
principles of, 371 
tables for, 526 
Copper, 168 
Cord, spinal, 133 
Cornea, 137 
Corpuscles of blood, 91 
Corrosive sublimate, 331, 337 
Cranial cavity, 30, 31 


Cranium, 29, 48 
Cream, 380 
Creolin, 331 
Crest, 50 
Cretinism, 126 
Crisis, 90 

Crystalline lens, 139 
Culdesac of Douglas, 155 
Cutaneous membrane, 68 
Cuts of meat, 392 
Cystocele, 156 

Defecation, 104 
Deglutition, 104, 106 
Deliquescence, 172 
Dental caries, 211 
Dermis, 119 
Desserts, 470 
Diaphoretics, 306 
Diaphragm, 30, 31, 82 
Diet, balanced, 391 
hospital, general, 419 
ideal, 360 

influence of temperament and 
disposition on, 364 
in advanced age, 363 
in disease, 408 
in health, 361 
light, 418, 419 
liquid, 418 
low protein, 420 
, mixed, 360 

principles of, 353 
soft, 418 

Dietaries, hospital, 418 
Dietetics, questions on, 518 
Digestion, definition, 177 
gastric, 106 
hygiene of, 209 
intestinal, 107, 181 
process of, 108 
Digestive ferments, 107 








INDEX 


535 


Digestive fluids, 179 
system, 104 
Digitalis, 304, 312 
Diphtheria, 234 
Schick test for, 239 
Dirt, 184, 203 
Disease, communicable, 231 
definition of, 251 
functional, 254 
germs of, 227 
organic, 254 
Disinfectants, 247, 329 
Disinfection, air, 248 
carpets and rugs, 208 
excreta, 248 
floors, 208 
linen, 205 
natural, 249 

rooms and contents, 249 
rules of, 247 
sinks, 206 
ward utensils, 205 
Disposition and temperament, in¬ 
fluence on diet, 364 
Diuretics* 304 
Dorsal surface of body, 29 
Douches, 294 
Douglas, culdesac of, 155 
Drugs, action of, 266 
administration of, 275 
adulteration of, 270 
astringent, 301 
condition of, 270 
dosage, 272 
idiosyncrasy, 269 
official, 257 

preparations of, producing wa¬ 
tery stools, 299 
rashes, 271 
sources of, 254 
therapeutic limit of, 272 
Ductless glands, 39, 125 


Duodenum, 71 
Dust, 184, 203 
Dysentery, 234 
Dyspepsia, 195 

Ear, 142 

Eating of meat, 400 
Effervescence, 172 
Efflorescence, 172 
Eggs, 384, 431 
Elaterium, 299 
Elementary chemistry, 157 
substances, 158 
table of, 160 

Elements and compounds, 165 
structural, 33 
Elimination, 117 
Emetics, 303 
Endocrine glands, 125 
Energy requirement of normal 
adults, 356 
children, 356 
Enzymes, 105, 107, 179 
Epiglottis, 83 
Epithelial cells, 35 
tissue, 38 
Epsom salt, 300 
Erect position of body, 57 
Ergot, 339 
Erysipelas, 236 
Esophagus, 69 
Ether, 328 

Eustachian tubes, 143, 146 
Evacuants, 295 
Examination of feces, 181 
of stomach contents, 181 
Excreting glands, 39 
Excretory organs, 39 
Exercise, 90, 220 
Expiration, 81 
Extensor muscles, 55 
External secretions, 125 





536 


INDEX 


Extract, pituitary, 126 
Eye, 136 

applications to, 291 
composition of, 136 
functions of, 136 
hygiene of, 216 

Face, muscles of, 51 
nerves of, 132 
Fallopian tubes, 79 
Farm animals, balanced feeding 
for, 367 
Fascia, 55, 58 
Fatigue, 64 
Fats, 177 
and oils, 169, 355 
Fatty tissue, 38 
Feces, examination of, 181 
principal constituents of, 181 
Feeding balanced, for farm ani¬ 
mals, 367 
of patients, 415 
Feet, bones of, 47 
care of, 215 
Femoral hernia, 155 
ring, 155 
Femur, 47 
Ferments, 180 
Ferrum, 162, 320 
Fever, scarlet, 234 
typhoid, 233 
yellow, 237 

Fevers, feeding in, 409 
symptoms of, 408 
Fibrin, 92 
Fibula, 47 

Field of chemistry, 157 
Filters, 194 
Fish, 389, 455 

Fistula between vagina and blad¬ 
der, 156 

and rectum, 156 


Flavors, 351, 413 
Flaxseed, 339 
Flesh foods, 372, 386 
Flexor muscles, 55 
Flour, 377, 398 
wheat, 367 

Fluids, gastric, 70, 107 
intestinal, 108 
nutritive, 32 
Foods, 353 
accessories of, 359 
adulteration of, 198 
animal, 386 
artistic touches, 413 
assimilation of, 109 
at different ages, 363 
breakfast, 399 
caloric value of, 358 
cereals as, 398 
classes, 176, 177 
comparative cost of, 368 
cooking of, 371 
deficiency of, 196 
digestibility of, 365 
eggs as, 384 
excess of, 197 
fish as, 389, 455 
flesh as, 372, 386 
fluid, 425 
fruit as, 404, 470 
heat-producing, 356 
infection of, 204 
inorganic, 354 
laxative, 397 
mineral, 354, 355 
miscellaneous, 487 
nitrogenous and non-nitrogen- 
ous, 354 

nutritive value of, 360 
organic, 354 
perfect, 358 

physiologic effects of, 315 



INDEX 


537 


Foods, preparation and serving, 
412 

products, artificial, 367 
refuse of, 357 

requirements, effects of tem¬ 
perament and disposition on, 
364 

semisolid, 436 
starchy, 377 

time needed for digesting, 366 
tissue-building, 356 
vegetable, 377, 400, 463 
Foramen, 50 
Formaldehyd, 208, 332 
fumigation, 208, 332 
Formalin solution, 332 
Formula, 162 
Fossa, 50 
ischiorectal, 154 
recto-uterine, 155 
Fracture, green-stick, 49 
Fright, pallor of, 103 
Fruits, 404, 460 
Fuels, 176 

Fumigation, 208, 332 

Gall-bladder, 73 
Ganglionic system, 128 
Gastric digestion, 104, 106 
fluid, 70, 106, 127 
juice, 180 

Gastropulmonary mucous mem¬ 
brane, 66 

Gelatin, 49, 355, 386 
Gelatinoids, 359 

Genito-urinary mucous mem¬ 
brane, female, 67 
male, 67 

Glands, 40, 120, 125 
axillary, 127 
ductless, 40, 125 
endocrine, 125 


Glands, excreting, 40 
gastric, 106 
lacrimal, 127, 140 
lymphatic, 111, 149 
mammary, 127, 149 
of internal secretions, 125 
parotid, 126 
pituitary, 125, 126 
prostate, 156 
salivary, 104, 106 
sebaceous, 120 
secreting, 40, 125 
secretions of, 125 
sex, 125 

submaxillary, 126 
sudoriferous, 127 
suprarenal, 126 
sweat, 120, 127 
three essentials of, 125 
thymus, 125, 126 
thyroid, 125, 126, 388 
Glenoid cavity, 45 
Glucose, 359, 403 
Gluten, 355 
Glycerin, 338 
Glycogen, 73 
Goiter, 126 
Gonads, 125 
Grease traps, 202 
Green-stick fracture, 49 
Gristle, 49 
Guaiacol, 328 
Gums, 367 

Habit, candy, 403 
Hair, 123 
Ham, 387 
Hand, bones of, 45 
hygiene of, 214 
Head, 48 
Health, 187 
Hearing, sense of, 142 




538 


INDEX 


Heart, 93 
sounds, 94 

Heat, 89, 103, 243, 306 
production, 177 
Heat-producing foods, 356 
Hemoglobin, 168 
Hernia, ventral, 153 
Hinge-joints, 60 
Hollow muscles, 55 
Hook-worm disease, 237 
Hormones, 126 
Hormonetherapy, 125, 257 
Hospital diet, general, 419 
dietaries, 418 
Hot air, 306 

Household antidotes, 524 
Humerus, 45 
Humidity, 165 
Hydrogen, 166, 353 
Hydroxids, 173 
Hygiene, definition of, 187 
of digestive system, 209 
of eye, 216 
of hands, 214 
of hospital ward, 203 
of mouth and teeth, 211 
of respiratory system, 212 
of skin, 211 
personal, 209 
questions on, 504 
Hyoscine hydrobromate, 324 
Hypertrophy of prostate gland, 
156 

of tonsils, 148 

Ice, 195, 329 
Ileum, 71 
Ilium, 47 

Immunity, 231, 239, 240 
Imponderable remedies, 255 
Incompatabilities, 174 
Incubation period, 238 


Index, opsonic, 239 
Infantile paralysis, 234 
Infection, 231 
contact, 240 

how admitted to body, 232 
carried, 232 
of food, 198, 204 
prevention of, rules for, 233 
sources of, 205 

to avoid taking and carrying, 
233 

Inflammation, mastoid, 146 
Influenza, 234 
Inguinal canal, 155 
hernia, 155 
ligament, 155 
region, 155 
ring, abdominal, 155 
Insalivation, 104, 106 
Inspiration, 81 
Intercellular substance, 35 
Intercostal muscles, 58 
Internal secretions, 125 
glands of, 125 

Intestinal digestion, 104, 107, 181 
fluids, 107, 108 
Intestines, 70 
divisions of, 70 
motion of, 71 

Invalid cookery, questions on, 
518 

Iodin, 167, 337 
Ipecac, 303 
Iris, 138 
Iron, 168, 320 
Ischiorectal fossa, 154 
Ischium, 47 

Jaborandi, 307 
Jejunum, 71 
Joints, 59 
varieties of, 60 




INDEX 


539 


Juice, gastric, 127 
pancreatic, 127 

Kidneys, 112, 113 
functions of, 74 
location of, 74 
structure of, 112 
Knee-joint, 60 
Koch, 225 
Koch’s law, 225 

Labarraque’s solution, 206 
Labyrinth of ear, 144 
Lacrimal fluid, 217 
glands, 127, 140 
Lactic acid, 173 
Lactose, 359 
Lamb, cuts of, 396 
Lanolin, 338 
Larynx, 83 
Law, Koch’s, 225 
Laws which govern nutrition, 358 
Laxatives, 296 
Lead, 169 
Leeuwenhoek, 221 
Left auricle, 93 
ventricle, 93 
Legs, bones of, 47 
muscles of, 47 
Life, 33 
Ligament, 59 
inguinal, 155 
Poupart’s, 155 
Ligaments, 60-63 
broad, 78 
round, 78 

Light diet, 418, 419 
Lime, 334 

Lime-water, 168, 340 
Linea alba, 152 
Liniments, 262 
Linseed, 339 


Liquid diet, 418 
Lister, 224 
Litmus test, 172 
Little bones, 42 
Liver, 127 
as food, 387 
functions of, 72 
location of, 72 
Low protein diet, 420 
Lungs, 84 
Lymph, 92 
function of, 92 
Lymphatic glands, 149 
system, 40, 110, 111 
Lymph-nodes, 149 
Lymph-vessels, 92, 111 
Lysis, 90 
Lysol, 331 

Magnesii sulphatis, 300 
Malaria, 236 
Malic acid, 173 
Mammary glands, 127, 149 
abscess of, 150 
Mass, 158 
Massage, 297 
Mastication, 104, 105 
Mastoid cells, 146 
inflammation, 146 
process, 50 

Materia medica, questions on, 
510 

Matter, 163 

Meal planning, rules for, 367 
Measles, 234 

Measures and weights, 259, 260 
Meat eating, 400 
extracts, 311 

Meats, classification of, 386 
composition of, 386 
cooking of, 372, 455 
cuts of, 392 



540 


INDEX 


Meats, quality of, 386 
Meatus urinarius, 112 
Median line of body, 29 
Medicinal preparations, 261 
Medicines, action of, 266 
administration of, 275 
fluid, 278 

precautions in using, 278 
prescriptions of, 266 
rules for giving, 276 
therapeutic limit, 272 
time for giving, 276 
Medulla oblongata, 131 
Membrane, cutaneous, 68 
mucous, 31, 67, 120 
gastropulmonary, 66 
genito-urinary, 67 
of stomach, 69 
serous, 67 
synovial, 63, 68* 

Mercury, 168, 336 
Mesentery, 154 
Mesocecum, 154 
Mesocolon, 154 
Mesorectum, 154 
Metabolism, 111, 175, 358 
Metacarpal bones, 45 
Metatarsal bones, 47 
Metric system, 523 
Micturition, 115 
Milk, 127 

administration of, 382 
adulteration of, 197 
bacteria in, 379 
comparative cost of, 384 
contamination of, 197, 198 
digestion of, 381 
for invalids, 379 
modification of, 381 
nutritive value of, 379 
predigestion of, 383 
skimmed, 380 


Milk, sterilization of, 197, 381 
Milk-sugar, 380 
Milt, 74 

Mineral drugs, 255 
elements, 354 
foods, 355 

Miscellaneous foods, 487 
Mitral valve, 93 
Mixed diet, 360 
Molecule, 159 
Morphin, 326 
Motor nerves, 129, 130 
Mouth, 31, 104 
and teeth, hygiene of, 211 
Mucous membrane, 31, 67, 120 
gastropulmonary, 66 
genito-urinary, 67 
Mucus, 120, 127 
Mumps, 235 
Muscle-fibers, 52 
Muscles, 31 
abductors, 59 
adductors, 59 
attachment to skeleton, 55 
biceps, 58 
diaphragm, 58 
extensors, 55 
flexors, 55 
function of, 51 
gluteal, 59 
hollow, 55 
intercostal, 58 
involuntary, 54 
nervous control of, 64 
oblique, inferior, 136 
superior, 136 
psoas, 59 
rectus, 136 

striped or striated, 53 
triceps, 58 
voluntary, 53, 58 
Muscular system, 39 



INDEX 


Mustard, 341 
Mutton, cuts of, 396 
Myosin, 355 
Myotics, 292 

Nails, 124 
Narcotic poisons, 341 
Nasal cavity, 31, 141 
Nerves, 31, 128-130 
Nerve-supply of blood-vessels, 
103 

Nervous control of muscles, 64 
system, 39, 128 
Nitrogen, 165, 353, 354 
Nitrogenous foods, 354 
Nitroglycerin, 311 
Nodes, lymph-, 149 
Non-siphon traps, 201 
Nose, 140 
Nourishment, 408 
Nucleus of cell, 33 
Nursing and bacteriology, 221 
Nutrition, laws which govern, 358 
principles of, 353 
•Nutritive fluids, 32 
Nux vomica, 311 

Obesity, 363 

Oblique muscles of eye, 136 
Occupation, 256, 364 
Odontoid process, 50 
Oil, castor, 297 
cod-liver, 320 
croton, 299 
of turpentine, 341 
olive, 298 

Oils and fats, 169, 355 
Olecranon, 50 
Olfactory cells, 35 
nerve, 141 
Oliguresis, 116 
Omentum, 154 


Opium, poisoning by, 327 
preparations of, 325 
uses of, 325, 326 
Opsonic index, 239 
Opsonins, 239 
Optic nerve, 138 
Orbital cavity, 31 
Organic compounds, 169 
Organotherapy, 125, 257 
Organs, excretory, 40 
of abdomen, 68 
of pelvis, 68 
of respiration, 39, 81 
of special sense, 136 
of thorax, 30 
Ossicles of ear, 42 
Ovaries, 79 
Oxalic acid, 173, 334 
Oxidation, 164, 165 
Oxygen, 88, 165, 190, 289 
Ozone, 190 

Paints, 185 
Palate, hard, 104 
soft, 82, 104 
Pallor of fright, 103 
Pancreas, 319 

Pancreatic fluid, 127, 181, 319 
Pancreatin, 319 
Paraldehyd, 325 
Paralysis, infantile, 234 
Paregoric, 326 
Parotid glands, 104, 126 
Pasteur, 223 
Pasteurization, 197 
Pelvic cavity, 30, 31 
organs of, 68 
Pelvis, 46 
female, 76 
Pepsin, 180, 319 
Peptones, 106 
Perineum, 80 






INDEX 


542 

Periosteum, 49 
Peristalsis, 71, 296 
Peritoneum, 75, 154 
Peroxid of hydrogen, 330 
Perspiration, 121, 122 
Petrolatum, 338 
Peyer’s patches, 71 
Phagocytes, 238 
Pharmacology, 257 
Pharmacopoeia, 257 
Pharmacy, 257 
Pharynx, 69, 82, 147 
Phenacetin, 327 
Phosphorus, 168 
and brain power, 390 
Physical and chemical changes, 
163 

Physiologic chemistry, 175 
Physiology, questions on, 493 
Pia mater, 130 
Pilocarpin, 307 
Pituitary extract, 126 
gland, 125, 126 
Plenciz, 222 
Pleura, 85 
Pleurisy, 86 
Plumbing, 199, 202 
Pneumonia, 236 
Poisoning, 341, 343 
Poisons and antidotes, 186, 341, 
343 

Poliomyelitis, acute, 234 
Pons varolii, 132 
Pork, cuts of, 397 
Postnasal growths, 148 
Potassium, 167 
iodid, 336, 337 
permangante, 334 
Poupart’s ligament, 155 
Precipitate, 171 
Prehension, 104 
Process, 50 


Process, alveolar, 50 
mastoid, 50 
odontoid, 50 

Prophylactic remedies, 255 
Prostate gland, 156 
abscess, 156 
hypertrophy of, 156 
Proteids, digestion of, 108 
Protein diet, low, 420 
Proteins, definition of, 177, 355 
Protoplasm, 33 
Psoas muscles, 59 
Ptomains, 197 
Ptyalin, 106, 180 
Pulse, 95 
Purees, 440 

Quinin, 321 

Quotient, respiratory, 358 

Rachitis, 49 
Radius, 45 
Reaction, 115, 162 
Recreation, 218 
Rectocele, 156 
Recto-uterine fossa, 155 
Rectum, 75, 156 
Rectus muscles, 136 
Reflex action, 134 
Refrigerator wastes, 202 
Remedial agents, 251 
Remedies, digestive, 317 
dosage of, 266 
effects of, 267 
imponderable, 255 
mechanical, 256 
prophylactic, 255 
sources of, 254 
Rennin, 180 
Reproduction of cell, 34 
Reproductive system, 40 
Respiration, 81, 87 




INDEX 


543 


Respiratory calorimeter, 178,358 
quotient, 358 
Retention, 115 
Rhubarb, 299 
Ribs, 44, 45 
Rickets, 49, 196 
Round ligaments, 78 
Rules for meal planning, 367 

Sacrum, 47 
Salads, 482 

Saliva, 104, 105, 127, 180 
Salivary glands, 104 
Salol, 327 

Salt, 167, 172-174, 329, 376 
Sandwiches, 446 
Saturated solutions, 171 
Scalp wounds, 145 
Scapula, 44 

Schick test for diphtheria, 239 
Secreting glands, 40, 125 
thyroid, 126 
Secretion, 119, 125 
Secretions, 127 
external, 125 
internal, 125 
glands of, 125 
Sedatives, 315, 321 
Seidlitz powder, 300 
Semmelweis, 223 
Sensations, 134 
Senses, organs of, 136 
Sensibility of skin, 119 
Serous membranes, 67 
Serum, 127 
Sex glands, 125 
Shoulder-blade, 44 
Sight, 136 
Silicon, 169 
Silver, 168 
Sinus, 50 
Siphon traps, 201 


Skeleton, 42, 51 
attachment of muscles to, 55 
Skin, sensibility of, 119 
Sleep, 136, 217 

Sleep-producing medicines, 280 
Small-pox, 237 
Smell, sense of, 141 
Sodium, 167 
Soft diet, 418 
Solute, 171 
Solution, 171 
salt, 310 

Solutions, disinfectant, 329 
saturated, 171 
Solvent, 171 
Soups, 375, 440 
Specific, 232, 336 
gravity, 115 

Sphincter muscle of bladder, 112 
Sphygmomanometer, 97 
Spinal canal, 30, 31 
column, 30 
cord, 30 
Spine, 50 

Spleen, 74, 125, 126 
Starch conversion, 182 
Starches, 367 
Starchy foods, 377 
Sterilization, 242, 244, 329 
Sternum, 44 
Stimulants, 308 
Stock, 376 
Stomach, 69 

contents, examination of, 181 
Structural elements, 33 
Strychnin, 311 

Subcutaneous tissue, use of, 119 
Sublingual glands, 104 
Submaxillary glands, 104, 126 
Substances, construction of, 158 
elementary, 158 
table of, 160 



544 


INDEX 


Sudoriferous glands, 127 
Sugar, 367 
in urine, 116, 117 
of milk, 359 
Sulphonal, 324 
Sulphur, 167, 333 
Suppression of urine, 116 
Suppuration, 241 
Suprarenal glands, 126 
Surfaces of body, 29 
Surgical anatomy, notes on, 145 
Sweat, 127 
glands, 120 
Symbols, atomic, 159 
chemists’, 162 
Symphysis pubis, 47 
Synovia, 68 

Synovial membrane, 63, 68 
Synthesis, 170 
Synthetic chemistry, 170 
Systems of body, 36 

Table of bones, 525 
Tables for cooking, 526 
Tartaric acid, 173, 261, 300 
Taste cells, 34 
sense of, 140 
Tea, 310, 405 
Tears, 127, 140 
Teeth, 104, 105 
and mouth, hygiene of, 211 
Temperament and disposition, 
influence on diet, 364 
Temperature, 89, 123, 525 
Tendons, 55 
uses of, 55 
Test, litmus, 172 
Schick, 239 
Therapeutics, 251 
questions on, 510 
Thoracic cavity, 30, 31, 45 
Thymus gland, 125, 126 


Thyroid deficiency, 126 
gland, 125, 126 
secretion, 126 
Tibia, 47 

Time for broiling, 526 
Tinctures, 262 
Tissues, 37 
Toast, 446 

Tongue, 104, 139, 140 
Tonics, 320 
Tonsils, 83, 104, 211 
hypertrophy of, 148 
Topographic areas, 151 
Touch, 140 
Trachea, 83 
Traps, 200 
grease, 202 
non-siphon, 201 
siphon, 201 
Treatment, 252 
Trional, 324 
Trunk, 30 

Tuberculosis, 236, 242 
Tuberosity, 50 
Tubes, Fallopian, 68, 77, 79 
Turbinated bones, 140 
Turpentine, 277, 301 
Typhoid fever, 233, 240 

Ulna, 45 

Umbilical ring, 153 
Umbilicus, 153 
Uncinariasis, 237 
Urea, 113, 182 
Ureters, 74, 112 
Urethra, 112 
Uric acid, 113, 182 
Urine, 113, 127 

abnormal constituents, 116, 
117 

albumin in, 116 
tests for, 116 



INDEX 


545 


Urine, casts in, 117 
chemical constituents of, 181 
sugar in, 116, 117 
Utensils for ward, 205 
Uterus, 68, 77, 79 
Uvula, 82, 104 

Vagina, 80 
Vaginal secretion, 127 
Valence, 162 

Values, calorific, table of, 179 
Valves, 93 
bicuspid, 93 
ileocecal, 71 
of heart, 93 
of veins, 99 
semilunar, 94 
tricuspid, 93 
Varnish, 185 
Vaselin, 338 
Vasoconstrictors, 103 
Vasodilators, 103 
Veal, cuts of, 395 
Vegetable bitters, 321 
Vegetables, 198, 356, 398 
cooking of, 377, 401, 463 
Vegetarianism, 400 
Vegetarians, 400 
Veins, 96, 101 
Ventilation, 191 
Ventral cavity, 30 
hernia, 153 
surface of body, 29 


Ventricles, 93, 94, 103 
Veratrum viride, 316 
Vermin, 203, 208 
Vertebral column, 30, 42 
Villi, intestinal, 72, 108 
Vitamins, 177 

Wafers, 446 
Warmth, 322 
Waste and repair, 41 
refrigerator, 202 
Water, 193, 296, 322 
uses of, 354 
Wax, 169 

Weight, atomic, 159 

Weights and measures, 259, 260 

Wheat flour, 367 

Whey, 380 

Whisky, 314 

Whooping-cough, 232 

Windpipe, 83 

Wines, 314 

Witch hazel, 339 

Work of body, 364 

Wounds, scalp, 145 

Wright, 239 

Wrist, 45 

Yeast, 377 

Zinc, 169 
Zingiber, 340 



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